Association between repeat head computed tomography scan and neurosurgical intervention in pediatric traumatic brain injury

Background

Though planned, repeat head computed tomography (CT) is increasingly common in pediatric traumatic brain injury (PTBI), the value of this approach has yet to be demonstrated.

Purpose

To determine whether repeat CT scans in the first 24 hours after PTBI result in neurosurgical intervention.

Methods

With IRB approval, all medical records of pediatric patients (<15 years old) admitted to a Level I trauma center for treatment of TBI between 2003 and 2008 were reviewed. Patient characteristics were compared using t-tests and chi-square tests between those with one CT and two CTs. Logistic regressions were used to obtain odds ratios. We also calculated the time intervals between the two CT scans and between the second CT and surgical intervention.

Results

Of the 920 reviewed patients, 33.4% had two CT scans.  Second CT scans were more frequently conducted within 12 hours (N=86, 47.0%). Patients with worsening results in their second CT scan were not significantly more likely to have surgical intervention (Odds Ratio=1.3, 95% confidence interval [CI], 0.6-2.7, p=0.4). Only 36.6% of the surgeries were done within 2 hours of the second scan.

Conclusions

Repeat head CT scans within 24 hours of PTBI are unlikely to result in neurosurgical interventions.  Of the few patients who underwent operations, only a small majority with undergo operation in less than two hours after the CT is performed.  These findings suggest that unselected, programmed repeat head CT in PTBI may be of limited clinical utility.