Research Reports - Value of repeat head computed tomography after traumatic brain injury

J Neurotrauma. 2014 Jan 1;31(1):78-98

Reljic T, Mahony H, Djulbegovic B, Etchason J, Paxton H, Flores M, Kumar A

Abstract Diagnosis and management of traumatic brain injury (TBI) is crucial to
improve patient outcomes. While initial head computed tomography (CT) scan is the
optimum tool for quick and accurate detection of intracranial hemorrhage, the
guidelines on use of repeat CT differ among institutions. Three systematic
reviews have been conducted on a similar topic; none have performed a
comprehensive meta-analysis of all studies. Search of Medline, the Cochrane
Library database, and Clinicaltrials.gov , and a hand search of conference
abstracts and references for all completed studies reporting data on change in
management following repeat CT was conducted. Two authors reviewed all studies
and extracted data using a standardized form. A proportional meta-analysis was
conducted using the random-effects model for outcomes related to any change in
management following repeat CT. Any change in management included intracranial
intervention, change in intracranial pressure monitoring, and/or administration
of drug therapy. Search results yielded 6982 references. In all, 41 studies
enrolling 10,501 patients were included. Change in management following repeat CT
was reported in 13 prospective and 28 retrospective studies and yielded a pooled
proportion of 11.4% (95% confidence interval [CI] 5.9-18.4) and 9.6% (95% CI
6.5-13.2), respectively. In a subgroup analysis of mild TBI patients (Glasgow
Coma Scale score 13 to 15), five prospective and nine retrospective studies
reported on change in management following repeat CT with the pooled proportion
across prospective studies at 2.3% (95% CI 0.3-6.3) and across retrospective
studies at 3.9% (95% CI 2.3-5.7), respectively. The evidence suggests that repeat
CT in patients with TBI results in a change in management for only a minority of
patients. Better designed studies are needed to address the issue of the value of
repeat CT in the management of TBI.

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