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Does distracting pain justify performing brain computed tomography in multiple traumas with mild head injury?
Homa Sadeghian1, Rouzbeh Motiei-Langroudi2
1Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
Abstract:
Traumatic brain injury (TBI) is a significant health concern classified as mild, moderate, and severe. Although the indications to perform brain computed tomography (CT) are clear in moderate and severe cases, there still exists controversy in mild TBI (mTBI). We designed the study to evaluate the significance of distracting pain in patients with mTBI. The study population included patients with mild traumatic brain injury (GCS ≥13). Moderate and high risk factors including age <18 months or ≥60 years, moderate to severe or progressive headache, ≥2 episodes of vomiting, loss of consciousness (LOC), post-traumatic amnesia, seizure or prior antiepileptic use, alcohol intoxication, previous neurosurgical procedures, uncontrolled hypertension, anticoagulant use, presence of focal neurologic deficits, deformities in craniofacial region, and penetrating injuries were excluded. The patients were then grouped based on presence (DP+) or absence (DP-) of another organ fracture with severe pain (based on VAS). The primary outcome was any abnormal findings on brain CT scans; 330 patients were enrolled (184 DP+ and 146 DP-). Overall, two DP+ and one DP- patients had mild cerebral edema in brain CT (p > 0.99). No patients had any neurologic symptoms or signs in follow-up. Our results show that in the absence of any other risk factors, distracting pain from other organs (limbs, pelvis, and non-cervical spine) cannot be regarded as a brain CT indication in patients with mild TBI, as it is never associated with significant intracranial lesions.
Insights
Distracting pain from other injuries is not an indication for brain CT scans in mild traumatic brain injury (mTBI) patients without other risk factors. Such pain does not correlate with significant intracranial lesions on CT scans.
Area of Science:
- Neuroscience
- Emergency Medicine
- Radiology
Background:
- Traumatic brain injury (TBI) is a major health issue with varying severity levels.
- Guidelines for brain computed tomography (CT) are established for moderate and severe TBI, but remain controversial for mild TBI (mTBI).
- The role of distracting pain in mTBI decision-making for CT imaging requires clarification.
Purpose of the Study:
- To evaluate the significance of distracting pain as an indication for brain CT in patients diagnosed with mild traumatic brain injury (mTBI).
- To determine if severe pain from other injuries (e.g., fractures) in mTBI patients is associated with intracranial lesions requiring CT evaluation.
Main Methods:
- A study population of 330 patients with mild traumatic brain injury (GCS ≥13) was analyzed.
- Patients with moderate to high-risk factors for intracranial injury were excluded.
- Participants were categorized into two groups: those with distracting pain (DP+) and those without (DP-), based on the presence of severe pain from other organ fractures.
Main Results:
- Brain CT scans revealed mild cerebral edema in only three patients (two DP+ and one DP-), with no statistically significant difference between groups (p > 0.99).
- No patients exhibited neurological symptoms or signs during follow-up.
- The study found no association between distracting pain and significant intracranial lesions in the studied mTBI cohort.
Conclusions:
- In mild traumatic brain injury (mTBI) patients without other identified risk factors, distracting pain from sources like limb or pelvic fractures is not a sufficient indication for brain CT.
- The presence of severe pain from other injuries, in the absence of other red flags, does not necessitate neuroimaging for mTBI assessment.
- Current findings suggest that focusing on established risk factors is crucial for appropriate CT utilization in mTBI cases.
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