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The Utility of Routine Serial Brain Computed Tomography for Referred Traumatic Brain Injury Patients According to the Severity of Traumatic Brain Injury  

Hwang, Jeong In (Department of Emergency Medicine, Dongguk university Ilsan hospital)
Cho, Jin Seong (Department of Emergency Medicine, Dongguk university Ilsan hospital)
Lee, Seung Chul (Department of Emergency Medicine, Dongguk university Ilsan hospital)
Lee, Jeong Hun (Department of Emergency Medicine, Dongguk university Ilsan hospital)
Publication Information
Journal of Trauma and Injury / v.22, no.2, 2009 , pp. 134-141 More about this Journal
Abstract
Purpose: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI. Methods: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI. Results: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals. Conclusion: Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.
Keywords
Hospital referral; Brain injury severity; Computed tomography;
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1 Wang MC, Linnau KF, Tirschwel DL, Hollingsworth W. Utility of repeat head computed tomography after blunt head trauma: a systemic review. J Trauma 2006;61:226-33   DOI   ScienceOn
2 Smith JS, Chang EF, Rosenthal G, Meeker M, von Koch C , Manley GT, et al. The Role of Early Follow-Up Computed Tomography Imaging in the Management of Traumatic Brain Injury Patients With Intracranial Hemorrhage. J Trauma 2007;63:75-82   DOI   ScienceOn
3 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480-4
4 Seo KS, Park JB. A study on patients transferred to emergency medical center of university hospital. J Korean Soc Emerg Med 1993;4:112-21
5 Figg RE, Burry TS, Vander Kolk WE. Clinical efficacy of serial computed tomography in severe head injury. J Trauma 2003;55:1061-4   DOI   ScienceOn
6 Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, et al. Progressive hemorrhage after head trauma: Predictors and consequences of the evolving injury. J Neurosurg 2002;96:109-16   DOI   ScienceOn
7 Rogers FB, Osler TM, Shackford SR, Cohen M, Camp L, Lesage M. Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting. J Trauma 1999;46:328-33   DOI   ScienceOn
8 Lee JH, Lim KS, Ahn R, Seo DW, Ahn S, Kim W, et al. The Evaluation of the Hospital Transfer Adequacy to the Tertiary Hospital in Trauma Patients. J Korean Soc Traumatology 2003;16:37-42
9 Kim EC, Cho YS, Choi YH, Chung HS, Park IC, Lee HS. Are you ready to transport your seriously ill patient?. J Korean Soc Emerg Med 2006;17:51-7
10 Brown CV, Zada G, Salim A, Inaba K, Kasotakis G, Hadjizacharia P, et al. Indications for routine repeat head computed tomography stratified by severity of traumatic brain injury. J Trauma 2007;62:1339-45   DOI   ScienceOn
11 Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: Does it benefit patients? J Trauma 2004;56:475-81   DOI   ScienceOn
12 Ko HS, Kim GT, Kang KH. Is Routinely repeated brain computed tomography necessary after traumatic brain injury in an emergency setting?. J Korean Soc Emerg Med 2007;18:554-62
13 Ahn KO, Hong JY, Kim Y, Jung KY. Appropriate interhospital transfer of emergent patients. J Korean Soc Emerg Med 2006;17:138-45
14 Velmahos GC, Gervasini A, Petrovick L, Dorer DJ, Doran ME, Spaniolas K, et al. Routine repeat head CT for minimal head injury is unnecessary. J Trauma 2006;60:494-501   DOI   ScienceOn