Save
Isolated subarachnoid hemorrhage in mild traumatic brain injury: is a repeat CT scan necessary?
Author(s): ,
R. Guatta
Affiliations:
University Hospital of Geneva, Geneva, Switzerland
,
A. May
Affiliations:
University Hospital of Geneva, Geneva, Switzerland
,
K. Tizi
Affiliations:
University Hospital of Geneva, Geneva, Switzerland
,
K. Schaller
Affiliations:
University Hospital of Geneva, Geneva, Switzerland
A. Bartoli
Affiliations:
University Hospital of Geneva, Geneva, Switzerland
EANS Academy. Guatta R. Oct 21, 2018; 225890; EP5023
Ramona Guatta
Ramona Guatta
Login now to access Regular content available to all registered users.

Access to Privileged content is currently a membership benefit.

Click here to join EANS or renew your membership.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Objective:
Traumatic brain injury (TBI) with isolated subarachnoid hemorrhage (iSAH) is a common pathology in the emergency department. In many centersa repeat CT scan is routinely performed at 24-72 hours to rule out further hemorrhage progression. In mild TBI patients (GCS 13-15) with iSAH findings, some authors suggest that a repeat head CT scan is of poor value. The aim of this study is to assess the clinical utility of the repeat CT scan in our hospital.

Methods:
We reviewed the medical charts of all patients with mild TBI and isolated SAH, between January 2015 and October 2017 in our institution. CT scan at admission and control at 24h to 72h were examined for each patient in order to detect any possible change.Neurological deterioration, antiplatelet/anticoagulant therapy (APT/ACT), coagulopathy,SAH location, associated injuries and length of stay in hospital were analysed. Differences in proportions were calculated with 95% confidence intervals (CIs).

Results:
A total of 106 patients with iSAH met the inclusion criteria.Radiological iSAH progression was found in 2 of 106 (1.89%, 95% CI 0.2% to 6.6%) patients, one of them was under antiplatelet therapy. No neurological deterioration was observed.Ten of 106 (9.4%) patients were under ACT and 28 of 106 (26.4%) were under APT.One patient with extensive iSAH in the sylvian fissure (but no aneurysm) beneficiated a transcranial doppler (TCD) with normal results.

Conclusion:
iSAH in TBI seems to show radiological stability over 72 hours with no neurological deterioration, regardless of ACT/APT and coagulopathy. Clinical utility of a repeat head CT in such patients is questionable, considering its radiation exposure and cost-effectiveness.Regardless of ACT/APT, a 24 hours neurologic observation and a symptomatic treatment solely could be a reasonable alternative. Medico legal controversies and lack of data warrant larger and more consistent studies in order to safely change our practice.
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings