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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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