NEW YORK (Reuters Health) – Routine repeat computed tomography (CT) scans aren’t necessary in patients with traumatic head injury who don’t have deteriorating neurological status, concludes a new study from Australia.

Research published in Annals of Surgery found that no patients getting a routine CT needed a medical or surgical change in management – while the repeat CTs were still useful in patients who had clinically indicated scans.

Dr. Julie Miller of the Royal Melbourne Hospital and her colleagues point out that given that lack of benefit, the costs and side effects associated with CT scans should make doctors think twice about whether additional scans are needed in patients with a head injury.

They conducted a prospective study of 591 patients treated for traumatic head injury at their hospital over a 20-month period. All were at least 18 years old and were given an initial CT scan when they were admitted.

Patients were a mean 12.8 on the Glasgow Coma Scale (3-15) at admission, and 80% had mild head injury.

About two-thirds of the patients (401) were discharged without any additional CT scans, after a median of 9.0 days.

The remaining 190 patients had a total of 305 repeat scans – 149 of those indicated by clinical deterioration or a rise in intracranial pressure, and 156 of them routine, with no clinical indications.

Of the 305 repeat scans, 71 showed an improvement, 64 a deterioration, and 169 no change.

No patients getting a routine repeat scan needed a change in management, even those with a scan that showed deterioration.

A change in management was, however, necessary for 28 patients (19%) who had clinically indicated repeat CT scans. Those patients were more likely to have a severe head injury and more likely to be younger than patients who did not need a change in management, which included craniotomy, sedation, and paralysis.

Combined with neurological deterioration, age and severity of trauma are reasonable factors to consider when deciding if repeated CT scans should be done, the authors wrote.

But they note that discretion should be used both because of the price tag of CT scans – generally a couple of thousand dollars each – and possible complications or side effects, including a slightly increased risk of cancer due to radiation exposure.

Dr. Miller and her colleagues concluded that “The routine use of serial computed tomography carries potential risks and consumes valuable resources without demonstrable benefit, and should be reconsidered in head-injured patients without clinical indications for repeat imaging.”

Reference:

Do Routinely Repeated Computed Tomography Scans in Traumatic Brain Injury Influence Management?: A Prospective Observational Study in a Level 1 Trauma Center

Annals of Surgery, 2011.