Necessity of Repeat Computed Tomography Imaging in Isolated Mild Traumatic Subarachnoid Hemorrhage

The standard of care for mild isolated traumatic subarachnoid hemorrhage (itSAH) involves serial head computed tomography (CT) examinations at dedicated time intervals to monitor neurologic status and hemorrhagic progression. Considering recent evidence questioning such an aggressive monitoring protocol, this study aimed to assess the necessity of repeat head CT imaging in managing itSAH.

All patients who presented to our academic institution with mild traumatic brain injury were evaluated. Patients ≥18 years of age presenting with mild, blunt itSAH (Glasgow Coma Scale [GCS] score 13-15) were included. Patients with significant polytrauma or coagulopathy were excluded. Patient demographics (age and sex), imaging results (CT progression), and outcomes (final GCS score, discharge status, interventions, and 30-day readmission) were all recorded.

Of 190 cases identified for inclusion, 58 (30.5%) met all study criteria (age, 59.5 ± 18.0 y; 30 men). Five (8.6%) patients presented with repeat CT progression, with none reporting 30-day readmission or adverse event on follow-up. Comparison of cases with and without CT progression found no meaningful differences in age or sex. Of the 3 patients readmitted, none demonstrated CT progression, and cause of readmission was unrelated to head trauma in all cases. Two patients demonstrated clinical deterioration (final GCS score <14), and neither case showed progression on CT, was readmitted, or received neurosurgical intervention of any kind.

Our findings suggest that serial CT imaging has little efficacy in changing mild itSAH management and is poorly correlated with clinical progression. A less aggressive management protocol may be more appropriate for managing this patient population.