Journal of Emergencies, Trauma, and Shock

EDITORIAL
Year
: 2018  |  Volume : 11  |  Issue : 1  |  Page : 1-

Whats New in Emergencies, Trauma and Shock? Computed Tomography Profile and its Utilization in Traumatic Brain Injury


Amit Agrawal1, Luis Rafael Moscote-Salazar2,  
1 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Neurosurgery, RED LATINO- Latin American Trauma, Intensive Neuro-Care Organization, Bogota, Colombia

Correspondence Address:
Dr. Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh
India




How to cite this article:
Agrawal A, Moscote-Salazar LR. Whats New in Emergencies, Trauma and Shock? Computed Tomography Profile and its Utilization in Traumatic Brain Injury.J Emerg Trauma Shock 2018;11:1-1


How to cite this URL:
Agrawal A, Moscote-Salazar LR. Whats New in Emergencies, Trauma and Shock? Computed Tomography Profile and its Utilization in Traumatic Brain Injury. J Emerg Trauma Shock [serial online] 2018 [cited 2021 Nov 28 ];11:1-1
Available from: https://www.onlinejets.org/text.asp?2018/11/1/1/225761


Full Text



The present study examines the role of computed tomography (CT) scan in patients with traumatic brain injury and discusses the demographic details, injury distribution, intracranial imaging findings, and identifies the risk factors to request a CT scan in patients with suspected traumatic brain injury (TBI).[1] It is beyond doubt that the CT is rapid, widely available, and one of the most valuable imaging modality to investigate patients with TBI in the emergency department.[2] The use of CT scan in the emergency department has been progressively increasing [3],[4],[5],[6] which not only has the potential to increase the cost of care [7],[8] but also the increased radiation exposure can lead to a harmful sequel.[3],[9],[10],[11] This study clearly identifies that CT is indicated in all patients with moderate and severe head injury (Glasgow Coma Scale ≤12), and there should be low threshold for asking a CT scan in elderly and in patients who are under influence of alcohol.[1]

In this study, the authors have found that in patients with minor head injury, there was strong association between CT scan positivity rate and the history of loss of consciousness of >5 min, history of vomiting, seizures, ear bleed, and/or nasal bleed.[1] Out of 1782 patients, 1341 patients were investigated for minor head injury, and only 38% of patients had a positive-CT scan with different pathologies and variable extent of intracranial lesions (might or might not had required neurosurgical intervention). The authors rightly point that the use of clinical predictors in patients with TBI may help to reduce unnecessary CT scans by a significant number. It is important to note that although the proportion of patients with positive CT scan was more in the moderate and severe head injury group, still a large number of patients in this group had apparently normal CT scan. It is well known that CT scan alone cannot rule out the structural damage to the brain and hence magnetic resonance imaging is a better modality to investigate such cases. It is known that CT has limitations in diagnosing diffuse axonal injury in early stages (it may be present in milder form in minor head injury group as well).

One more aspect we need to take into consideration is nonclinical factors, which include relative decision to get a CT scan in minor head injury patients, patient expectations, anxiety, fear of litigation, risk missed diagnoses, and where there are inadequate facilities to monitor the patients.[12],[13],[14] Ultimately based on the circumstances, there will be a need to continue to make individual decisions as “Clinical practice guidelines are not perfect as they apply to populations, not to individual patients.”[12]

References

1Waganekar A, Sadasivan J, Prabhu AS, Harichandrakumar KT. Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study. J Emerg Trauma Shock 2018;11:27-32.
2Sun Z, Ng KH, Vijayananthan A. Is utilisation of computed tomography justified in clinical practice? Part I: Application in the emergency department. Singapore Med J 2010;51:200-6.
3Mettler FA Jr., Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, et al. Medical radiation exposure in the U.S. In 2006: Preliminary results. Health Phys 2008;95:502-7.
4Shinagare AB, Ip IK, Abbett SK, Hanson R, Seltzer SE, Khorasani R, et al. Inpatient imaging utilization: Trends of the past decade. AJR Am J Roentgenol 2014;202:W277-83.
5Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency department computed tomography utilization in the United States and Canada. Ann Emerg Med 2013;62:486-94.e483.
6Feng LB, Pines JM, Yusuf HR, Grosse SD. U.S. Trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001-2009. Acad Emerg Med 2013;20:1033-40.
7Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006;12:290-5.
8Brinjikji W, Kallmes DF, Cloft HJ. Rising utilization of CT in adult fall patients. AJR Am J Roentgenol 2015;204:558-62.
9Verdun FR, Gutierrez D, Vader JP, Aroua A, Alamo-Maestre LT, Bochud F, et al. CT radiation dose in children: A survey to establish age-based diagnostic reference levels in Switzerland. Eur Radiol 2008;18:1980-6.
10Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57.
11McCollough CH, Guimarães L, Fletcher JG. In defense of body CT. AJR Am J Roentgenol 2009;193:28-39.
12Melnick ER, Shafer K, Rodulfo N, Shi J, Hess EP, Wears RL, et al. Understanding overuse of computed tomography for minor head injury in the emergency department: A Triangulated qualitative study. Acad Emerg Med 2015;22:1474-83.
13Probst MA, Kanzaria HK, Schriger DL. A conceptual model of emergency physician decision making for head computed tomography in mild head injury. Am J Emerg Med 2014;32:645-50.
14Rohacek M, Albrecht M, Kleim B, Zimmermann H, Exadaktylos A. Reasons for ordering computed tomography scans of the head in patients with minor brain injury. Injury 2012;43:1415-8.