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1 Necessity of Repeat Computed Tomography Imaging in Isolated Mild Traumatic Subarachnoid Hemorrhage
ضرورت تکرار تصويربرداری تاموگرافی کامپيوتر در خونريزي سوباراکونوئيد تروماتيک خفيف-2018
I n a paper titled “Necessity of Repeat Computed Tomogra- phy Imaging in Isolated Mild Traumatic Subarachnoid Hem- orrhage,” Kumar et al1 challenged their institutional practice of managing patients with mild traumatic brain injuries (TBIs) with evidence of traumatic subarachnoid hemorrhage (tSAH). The practice at their facility (Kansas, United States) was for patients with mild TBIs with evidence of tSAH on an initial head computed tomography (CT) scan to be admitted to an intensive care unit setting for hourly observation checks and, even if unchanged, repeat head CT scans at 6 and 24 hours post injury. They referred in their article (and provided specific references) to several studies that had evaluated the necessity of intensive care unit admission and repeat cerebral imaging (usually specified time serial CT head scans) within 24 hours of a mild TBI with intracerebral hemorrhage. Most studies evaluated TBI in the context of any intracranial hemorrhage identified on the initial imaging. The debate that stimulated their submission and challenged practice was whether there was a subset with mild TBIs and only tSAH on initial imaging (without a known coagulopathy or on antiplatelet or anticoagulation medication) that was overusing resources, with associated costs, but also increasing unnecessary radiation exposure.
Key words: Blunt head trauma | CT scan | Cranial bleeding | Subarachnoid hemorrhage | Trauma
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