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. 2021 Mar 15;88(4):773-778.
doi: 10.1093/neuros/nyaa504.

Pathway-Based Reduction of Repeat Head Computed Tomography for Patients With Complicated Mild Traumatic Brain Injury: Implementation and Outcomes

Martina Stippler  1 , Stacey Keith  2 , Emmalin B Nelton  1 , Charles S Parsons  2 , Jennifer Singleton  3 , Leslie A Bilello  4 , Carrie D Tibbles  4 , Roger B Davis  5 , Jonathan A Edlow  4 , Carlo L Rosen  4
Affiliations

Pathway-Based Reduction of Repeat Head Computed Tomography for Patients With Complicated Mild Traumatic Brain Injury: Implementation and Outcomes

Martina Stippler et al. Neurosurgery. .

Abstract

Background: Routine follow-up head imaging in complicated mild traumatic brain injury (cmTBI) patients has not been shown to alter treatment, improve outcomes, or identify patients in need of neurosurgical intervention. We developed a follow-up head computed tomography (CT) triage algorithm for cmTBI patients to decrease the number of routine follow-up head CT scans obtained in this population.

Objective: To report our experience with protocol implications and patient outcome.

Methods: Data on all cmTBI patients presenting from July 1, 2018 to June 31, 2019, to our level 1, tertiary, academic medical center were collected prospectively and analyzed retrospectively. Descriptive analysis was performed.

Results: Of the 178 patients enrolled, 52 (29%) received a follow-up head CT. A total of 27 patients (15%) were scanned because of initial presentation and triaged to the group to receive a routine follow-up head CT. A total of 151 patients (85%) were triaged to the group without routine follow-up head CT scan. Protocol adherence was 89% with 17 violations.

Conclusion: Utilizing this protocol, we were able to safely decrease the use of routine follow-up head CT scans in cmTBI patients by 71% without any missed injuries or delayed surgery. Adoption of the protocol was high among all services managing TBI patients.

Keywords: CT; Mild TBI; Radiology; Traumatic brain injury; Triage.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1.
FIGURE 1.
cmTBI protocol used to triage need for follow-up head CT scan. CT = computed tomography; SDH = subdural hematoma; EDH = presence of epidural hematoma.
FIGURE 2.
FIGURE 2.
This flow diagram shows the triage of patients according to the cmTBI protocol, number of head CT scans, and violations. CT = computed tomography; SDH = subdural hematoma SDH; EDH = presence of epidural hematoma.
FIGURE 3.
FIGURE 3.
Patient characteristics compared between patients who were triaged to no follow-up head CT scan, triaged to have a follow-up head CT scan, and who received a head CT scan because of a violation of the protocol. SDH = subdural hematoma; tSAH = traumatic subarachnoid hemorrhage; EDH = epidural hematoma; GCS = Glasgow Coma Scale; anticoag = use of anticoagulant except aspirin; CT = computed tomography; f/u = follow-up.
See this image and copyright information in PMC

References

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