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. 2023 Jun;49(3):1189-1198.
doi: 10.1007/s00068-022-01902-5. Epub 2022 Feb 18.

Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey

Alfonso Lagares  1   2 , Ana María Castaño-Leon  3 , Marion Richard  4 , Parmenion Philip Tsitsopoulos  5 , Julian Morales  6 , Podaru Mihai  7 , Vladislav Pavlov  8 , Odile Mejan  9 , Javier de la Cruz  10 , Jean François Payen  4 ; BRAINI investigators
Collaborators, Affiliations

Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey

Alfonso Lagares et al. Eur J Trauma Emerg Surg. 2023 Jun.

Abstract

Purpose: Clinical guidelines have been developed to standardize the management of mild traumatic brain injury (mTBI) in the emergency room, in particular the indication of brain CT scan and the use of blood biomarkers. The objective of this study was to determine the degree of adherence to guidelines in the management of these patients across four countries of Southern Europe.

Methods: An electronic survey including structural and general management of mTBI patients and six clinical vignettes was conducted. In-charge physicians from France, Spain, Greece and Portugal were contacted by telephone and email. Differences among countries were searched using an unconditional approach test on contingency tables.

Results: One hundred and eighty eight physicians from 131 Hospitals (78 Spain, 36 France, 12 Greece and 5 Portugal) completed the questionnaire. There were differences regarding the in-charge specialist across these countries. There was variability in the use of guidelines and their adherence. Spain was the country with the least guideline adherence. There was a global agreement in ordering a brain CT for patients receiving anticoagulation or platelet inhibitors, and for patients with seizures, altered consciousness, neurological deficit, clinical signs of skull fracture or signs of facial fracture. Aging was not an indication for CT in French centres. Loss of consciousness and posttraumatic amnesia were considered as indications for CT more frequently in Spain than in France. These findings were in line with the data from the 6 clinical vignettes. The estimated use of CT reached around 50% of mTBI cases. The use of S100B is restricted to five French centres.

Conclusions: There were large variations in the guideline adherence, especially in the situations considered to order brain CT after mTBI.

Keywords: Adult; Clinical guidelines; Computed tomography; Mild traumatic brain injury; Survey.

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Conflict of interest statement

Vlad Pavlov and Odile Mejan are employees of bioMérieux.

Figures

Fig. 1
Fig. 1
Guideline use and guideline adherence among four European countries surveyed
Fig. 2
Fig. 2
Factors determining the use of cranial CT
Fig. 3
Fig. 3
Responses to clinical vignettes among physicians
Fig. 4
Fig. 4
Physician perceived use of CT in mild TBI management
See this image and copyright information in PMC

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