Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan

• Published in: Journal of the American College of Surgeons Vol. 214; no. 6; pp. 965 - 972
• Main Authors: Muakkassa, Farid F., MD, FACS, Marley, Robert A., MD, FACS, Paranjape, Charudutt, MD, FACS, Horattas, Elya, BS, Salvator, Ann, MS, Muakkassa, Kamel, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Biological and medical sciences; Brain Injuries - diagnostic imaging; Diagnosis, Differential; False Negative Reactions; Female; Follow-Up Studies; General aspects; Head Injuries, Closed - diagnostic imaging; Humans; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Surgery; Tomography, X-Ray Computed - methods; OR; NPG; NNG; ISS; traumatic brain injury; negative to positive CT scan group; odds ratio; motor vehicle crash; Injury Severity Score; negative to negative CT scan group; Glasgow Coma Scale; GCS; TBI; MVC; Human; Medicine; Head; Treatment; Radiodiagnosis; Surgery; Prediction; Medical imagery; Patient; Computerized axial tomography; Predictive factor; Hemorrhage
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2012.02.004

Background Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. Study Design Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. Results There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 ± 22.5 years vs NPG, 45.2 ± 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 ± 8.1 vs NPG, 17.9 ± 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 ± 3.5 vs NPG, 10.9 ± 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95%CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). Conclusions Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted.