Who Does Not Need Repeat Imaging for Traumatic Intracranial Hemorrhage?

Consensus is lacking about routine repeat head computed tomography (CT) in patients with intracranial hemorrhage; however, recent research suggests that, in the absence of neurologic deterioration, repeat imaging is unnecessary (NEJM JW Emerg Med Sep 27 2013). Now, researchers in Arizona have prospectively evaluated 1129 adult patients admitted to a single trauma center with intracranial hemorrhage on initial head CT. All patients received neurologic examinations every 2 hours and routine repeat head CT at 6 hours or for neurologic deterioration. No patient was anticoagulated or on antiplatelet therapy.

Of 1099 patients who underwent routine repeat imaging, 216 had a new or enlarged hemorrhage. Only four of these patients (all of whom had Glasgow Coma Scale scores <8 on presentation and were intubated) required neurosurgery for enlarging epidural or subdural hemorrhages. Of 30 patients who required repeat imaging for new altered mental status, neurologic deficits, or pupillary changes, 16 had new or enlarged hemorrhage; of this subset of patients, 12 required neurosurgery. Deteriorating neurologic examination was an independent predictor of need for neurosurgical intervention (odds ratio, 3.98).