Evidence-based indications for repeat head CT after mild traumatic brain injury: a systematic review and
Graziano Taddei1, Stefano Caproni2, Andrea Pietrantonio3
1Department of Neurosurgery, ASL Latina, Latina, Italy. g.taddei@ausl.latina.it.
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The effectiveness of routine repeat head computed tomography (CT) for mild traumatic brain injury (mTBI) is a subject of ongoing debate, with considerable variation in clinical practices. This systematic review and meta-analysis aimed to assess the evidence comparing routine and selective repeat CT protocols for mTBI patients. A comprehensive search was performed in PubMed and the Cochrane Library for studies published in the last two decades. The studies included adult mTBI patients who underwent repeat head CT during their hospital stay. The primary outcome measured was the necessity for neurosurgical intervention, while secondary outcomes included radiological progression, neurological deterioration, and mortality rates. The analysis of 37 studies, encompassing 17,857 patients, revealed that the rates of neurosurgical intervention were similar for routine (2.8%, 95% CI: 1.9-3.7%) and selective CT protocols (3.2%, 95% CI: 2.1-4.3%; RR: 0.88, 95% CI: 0.71-1.09, p = 0.24). Hemorrhage progression occurred in 7.63% of cases (95% CI: 7.24-8.03%), with comparable rates across both protocols (routine: 11.2% vs. selective: 9.8%, p = 0.29). Significant risk factors for clinical deterioration included an intracranial hemorrhage volume greater than 10 ml (OR 20.13, 95% CI: 5.67-71.44), the presence of multiple lesions (OR 11.03, 95% CI: 1.32-92.06), and temporal contusion (OR 5.73, 95% CI: 2.20-14.89). This meta-analysis indicates that selective CT protocols lead to similar clinical outcomes as routine scanning protocols in patients with mTBI. The overall low rate of neurosurgical intervention (2.05%) implies that close clinical observation and risk stratification may be as effective as universal repeat imaging. By implementing selective protocols based on identified risk factors, it may be possible to enhance patient safety while decreasing unnecessary imaging and healthcare costs. Further research should focus on validating risk-based protocols and determining the optimal timing for repeat imaging in patients at high risk.
