Indications and timing for CT scan in traumatic brain injury and analysis of CT scan findings

Trauma is a major health problem and is a leading cause of death in the age group 1 – 45 yrs. Head injuries caused or contributed to death in most trauma fatalities. The primary goal of imaging the trauma patient is to quickly and accurately identify treatable lesions before secondary injury to the brain occurs. CT scan is ideally suited to evaluate patients immediately after trauma. Head injury remains one of the most common reasons for seeking medical attention after injury: it is been estimated that more than 1.5 million people are treated for head injuries annually in the United States. (1) Cranial CT-scan is the most frequently performed radiological investigation in developed countries. (2) Computed tomography (CT) is valuable for the detection of structural damage to the brain resulting from head injury and has revolutionized the care of patients with head trauma. (3-5) It also obviates angiography and other invasive diagnostic procedures for the evaluation of most acute traumatic cerebral lesions that require immediate surgical intervention. (5-9) A CT scan is probably recommended for all patients including patients with mild head injury because one in five will have an acute lesion detectable by the scan. (10) The primary goal of the present study is to describe the indications and findings on CT in patients with traumatic brain injuries from a rural set up. Material and methods In this prospective study consecutive patients with traumatic brain injuries who underwent the CT scan will be included. Approval was obtained from the institution's ethical committee. As part of this study, one independent specialist radiologists (unaware of the patient details and outcomes) and another independent specialist radiologist (aware of the patient details and outcomes) were assessed each CT scan and grade the findings as per predesigned proforma. The main proforma included age and the presence or absence of headache (whether diffuse or local, vomiting), drug or alcohol intoxication, deficits in short-term memory, post-traumatic seizure, history of coagulopathy, and physical evidence of trauma above the clavicles. Head injury was defined as mild, moderate or severe based on Glasgow Coma Scale (GCS) following nonsurgical resuscitation, within the first 6 hours of injury. (11) Physical evidence of trauma was noted as any external evidence of injury, including contusions, abrasions, lacerations, deformities, and signs of facial or skull fracture. All patients with positive CT scans were admitted by the neurosurgical team and will be followed until discharge …