A REVIEW OF SERIAL BRAIN CT IN PATIENTS WITH TRAUMATIC BRAIN INJURY: A TERTIARY CARE EXPERIENCE

Arif Abubakar Ahmed

A REVIEW OF SERIAL BRAIN CT IN PATIENTS WITH TRAUMATIC BRAIN INJURY: A TERTIARY CARE EXPERIENCE

Arif Abubakar Ahmed

Abstract

Background : Traumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. The annual incidence of head injury in Pakistan has been estimated as 50/100,000 population based on data from public sector hospitals. Studies based on routine follow-up CT imaging have shown that approximately 20% to 50% of patients with TBI will develop progressive hemorrhagic injury (PHI).

Objective: To identify and study the importance of serial brain CT brain imaging in Traumatic Brain Injury (TBI) and analyze their evolution to redefine treatment strategies for trauma research in our region.

Materials and Methods: It is a retrospective study analyzing head trauma patients presenting to our emergency department over a period of six months between July and December 2016 in Liaquat National Medical College and Hospital, Karachi. Out of 468 patients, 202 patients were followed up and their data was recorded.

Results: Out of all the causes, Road Traffic accidents (RTA) was most common cause 125 patients (61.8%). The most frequent age group affected was between the age of 31-50 years. Intraparenchymal contusions (IPC) was the most frequent CT finding found in 78.7% of the patients and the least common finding was pneumocranium only 10.8%.

On follow up studies, out of the 202 patients, 54 of them had significant increase since their last control CT and the remaining 148 had either stable or resolution in their findings. Patients with moderate GCS [≥9-12], Intraparenchymal contusion (IPC) and subdural hematoma (SDH) were the common factors that were found to contribute to progressive hemorrhagic injury (PHI).

Conclusion: The results of our study suggest that follow up imaging after TBI allows for more suitable patient care, like the facilitation in identifying this specific group of patients and warranting change in their treatment plan, either conservative or surgical. This will result in a potentially favorable outcome.

Keywords: Accident, Contusion, CT scan brain, Head trauma, Traumatic brain injury (TBI)

Full Text:

PDF

References

Soares de Souza, R., Pessoa Pinheiro, P., Ferreira de Lima Silva, J., Leite Rolim Neto, M. and Machado Filho, J. (2015). Traumatic brain injury (TBI): morbidity, mortality and economic implications. International Archives of Medicine.

Umerani MS, Abbas A, Sharif S. Traumatic brain injuries: experience from a tertiary care center in Pakistan. Turk Neurosurg 2014; 24(1): 19-24.

Ali Raja, I., Habib Vohra, A. and Ahmed, M.B., B.S., M. (2001). Neurotrauma in Pakistan. World Journal of Surgery, 25(9), pp.1230-1237.

Escobedo, L. (2013). Traumatic brain injury: A case-based review. World Journal of Emergency Medicine, 4(4), p.252.

Eroglu, S., Onur, O., Ozkaya, S., Denızbasi, A., Demır, H. and Ozpolat, C. (2019). Analysis of Repeated CT Scan Need in Blunt Head Trauma.

Doddamani, R., Gupta, S., Singla, N., Mohindra, S. and Singh, P. (2012). Role of repeat CT scans in the management of traumatic brain injury. The Indian Journal of Neurotrauma, 9(1), pp.33-39.

Aziz, H., Rhee, P., Pandit, V., Ibrahim-Zada, I., Kulvatunyou, N., Wynne, J., Zangbar, B., O’Keeffe, T., Tang, A., Friese, R. and Joseph, B. (2013). Mild and moderate pediatric traumatic brain injury. Journal of Trauma and Acute Care Surgery, 75(4), pp.550-554.

Umerani, M., Abbas, A., Bakhshi, S., Qasim, U. and Sharif, S. (2016). Evolving brain lesions in the follow-up CT scans 12 h after traumatic brain injury. Journal of Acute Disease, 5(2), pp.150-153.

Wurmb, T., Schlereth, S., Kredel, M., Muellenbach, R., Wunder, C., Brederlau, J., Roewer, N., Kenn, W. and Kunze, E. (2014). Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury. BioMed Research International, 2014, pp.1-6.

Ding, Jun & Yuan, Fang & Guo, Yan & Chen, Shi-Wen & Gao, Wen-Wei & Wang, Gan & Cao, He-Li & Ju, Shi-Ming & Chen, Hao & Zhang, Peng-Qi & Tian, Heng-Li. (2012). A prospective clinical study of routine repeat computed tomography (CT) after traumatic brain injury (TBI). Brain injury : [BI]. 26. 1211-6. 10.3109/02699052.2012.667591.

Velmahos GC, Gervasini A, Petrovick L, et al. Routine repeat head CT for minimal head injury is unnecessary. J Trauma. 2006;60:494–501.

Clinical Gate. (2019). Surgical Management of Traumatic Brain Injury. [online] Available at: https://clinicalgate.com/surgical-management-of-traumatic-brain-injury/ [Accessed 2 Nov. 2019].

Wang MC, Linnau KF, Tirschwell DL, Hollingsworth W. Utility of repeat head computed tomography after blunt head trauma: a systematic review. J Trauma. 2006;61:226–233

Servadei F, Nanni A, Nasi MT, et al. Evolving brain lesions in the first 12 after head injury: analysis of 37 comatose patients. Neurosurgery. 1995;37:899e907.

Oertel M, Kelly DF, McArthur D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96:109e116.

Alahmadi, H., Vachhrajani, S. and Cusimano, M. (2010). The natural history of brain contusion: an analysis of radiological and clinical progression. Journal of Neurosurgery, 112(5), pp.1139-1145.

Sifri ZC, Livingston DH, Lavery RF, Homnick AT, Mosenthal AC, Mohr AM, Hauser CJ: Value of repeat cranial computed axial tomography scanning in patients with minimal head injury. Am J Surg 187:338 –342, 2004

Hill, E., Stiles, P., Reyes, J., Nold, R., Helmer, S. and Haan, J. (2017). Repeat head imaging in blunt pediatric trauma patients. Journal of Trauma and Acute Care Surgery, 82(5), pp.896-900.

Wintermark, M., Sanelli, P., Anzai, Y., Tsiouris, A., Whitlow, C., Druzgal, T., Gean, A., Lui, Y., Norbash, A., Raji, C., Wright, D. and Zeineh, M. (2015). Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques. Journal of the American College of Radiology, 12(2), pp.e1-e14.

Stiell, I., Wells, G., Vandemheen, K., Clement, C., Lesiuk, H., Laupacis, A., McKnight, R., Verbeek, R., Brison, R., Cass, D., Eisenhauer, M., Greenberg, G. and Worthington, J. (2001). The Canadian CT Head Rule for patients with minor head injury. The Lancet, 357(9266), pp.1391-1396.

Refbacks

There are currently no refbacks.