ROLE OF REPEAT CT SCAN IN DETECTING DELAYED INTRACRANIAL BLEED

• Published in: Journal of evolution of medical and dental sciences Vol. 4; no. 25; pp. 4250 - 4254
• Main Authors: Nayak, Madhukar T, Kumar, Purohit Aniruddh
• Format: Journal Article
• Language: English
• Published: Akshantala Enterprises Private Limited 26.03.2015
• Subjects: CAT scans; Diagnostic imaging; Emergency medical services; Head injuries; Medical research; Mortality
• ISSN: 2278-4748; 2278-4802
• DOI: 10.14260/jemds/2015/614

BACKGROUND: Radiological evaluation of a patient using CT scan brain has become an essential attribute in the emergency management a patient with head injury. Virtually every patient who presents in the emergency room with head injury undergoes an immediate CT scan of the brain. This leaves lot of room for missing delayed bleeds and evolving lesions which might sometimes prove prohibitive. In this context, a policy of electively repeating the CT scan brain in all patients undergoing the first CT scan within 6 hours of the injury was adopted. METHODS: All patients included [n=42] in the study were admitted under Neurosurgical unit headed by the senior author [AKP] between December 2010 and November 2011 and had presented within 6 hours of the incident. All the patients were subjected to repeat CT brain, on the coming early morning with an effective duration of 18-24 hours post head injury. Patients were evaluated clinically and radiologically. The data was tabulated and statistically analysed. RESULTS: The commonest age group was 18-60 yrs [n=26] which constituted 61.9%. The Male: Female ratio was 11: 3. The cause of head injury was high velocity road traffic accident [vehicle rider] in [n=28] 66.6% {Group A} and low velocity road traffic accident [pedestrian] or assault by blunt object in [n=14] 33.3% {Group B}. Early mean GCS was 15 & 14.92 in groups A & B compared to 14.07 & 15 delayed GCS score. Adverse outcome [need for surgical intervention, need for anti-edema measures (Inj. Mannitol, Inj. Furosemide) or ventilatory support] was seen in 0% & 14.29% [n=4] in groups A & B. There was 0% & [n=2] 7.1% mortality in A & B groups respectively. The overall mortality was [n=2] 4.8%. CONCLUSIONS: With the easy accessibility of early CT scan brain becoming a reality, missing delayed bleeds is surely a cause for concern. In this context, resorting to routine repeat CT scan brain seems to be a logically sound step, not with-standing the increased burden on the healthcare setup as well as the increased risk of radiation exposure. This aspect needs further validation using larger well- structured studies so that a statistically sound guideline be elucidated. KEYWORDS: Head injury, CT scan brain, delayed intracranial bleed, evolving intracranial lesions, cranio cerebral trauma.