Evaluation of Sequential Head Computed Tomography in Traumatic Brain Injuries

Area of Science:

• Radiology
• Neurosurgery
• Trauma Care

Background:

• Head trauma severity grading is crucial for acute patient management and follow-up planning.
• The Rotterdam CT score's utility in guiding sequential CT imaging and radiation dose requires further investigation.
• Establishing a correlation between Rotterdam scores, sequential CTs, and radiation dose can optimize patient care protocols.

Purpose of the Study:

• To establish a correlation between Rotterdam CT scores, the necessity for sequential CT scans, and cumulative radiation dose in traumatic head injury patients.
• To develop a preliminary protocol for patient management and follow-up based on Rotterdam CT scores.
• To reduce unnecessary radiation exposure in patients with traumatic head injuries.

Main Methods:

• Retrospective study of 88 traumatic head injury cases with at least one sequential CT scan from August 2014 to December 2020.
• Sequential head CTs were evaluated by experienced, blinded radiologists for Rotterdam CT scores (RCTS).
• Analysis focused on the progression of extradural hemorrhage (EDH) and subdural hemorrhage (SDH) based on initial RCTS.

Main Results:

• Only 28.6% of extradural hemorrhage (EDH) cases and 75.5% of subdural hemorrhage (SDH) cases showed progression on sequential CTs.
• Patients with baseline Rotterdam scores of 4 (76.9%) and 5 (100%) demonstrated significant disease progression (P = 0.001).
• Maximum serial CTs (up to three) were needed for score 3 cases, but often without significant findings.

Conclusions:

• Sequential CT is not indicated for Rotterdam scores 1 or 2 unless clinical deterioration occurs.
• Rotterdam score 3 warrants a 24-hour sequential CT, while scores 4 and 5 require a 12-hour sequential CT if surgical intervention is delayed.
• The Rotterdam score effectively predicts the need for further CT scans, thereby minimizing radiation exposure.