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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2021

Open Access 01-10-2021 | Central Nervous System Trauma | Original Article

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Authors: Tomas Vedin, Mathias Karlsson, Marcus Edelhamre, Linus Clausen, Sebastian Svensson, Mikael Bergenheim, Per-Anders Larsson

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2021

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Abstract

Purpose

Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention.

Methods

A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived “low-risk proposal” and applied retrospectively to the cohort.

Results

Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention.

Conclusion

For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.
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Metadata
Title
A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety
Authors
Tomas Vedin
Mathias Karlsson
Marcus Edelhamre
Linus Clausen
Sebastian Svensson
Mikael Bergenheim
Per-Anders Larsson
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01145-x

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