Not practice-changing, but an interesting observational report regarding when these authors found value in performing a repeat head CT after minor head trauma.
Specifically, they looked at a subgroup of patients whose initial head CT was normal after blunt trauma, but received a repeat head CT an average of ~8 hours later for an abnormal neurologic examination. These abnormal neurologic examinations were further stratified into three groups – a “persistently abnormal” exam, a “acute deterioration” in neurologic examination, and a catchall “unknown” group. The first two groups had mean GCS of 12.4 and 14.5 – but the reason why the “unknown” group is what it is – their average GCS is 4.
They found that repeating the head CT in the 61 patients they had with persistently abnormal neurologic examinations did lead to some worsening of the initial findings – but did not change management in any cases. However, 6 of the 21 patients who had an acute deterioration had a change in management, as well as 1 patient in the unknown group.
Small sample, but interesting, nonetheless.
“Utility of Repeat Head Computed Tomography in Patients With an Abnormal Neurologic Examination After Minimal Head Injury.”
www.ncbi.nlm.nih.gov/pubmed/21857258