Protocol to Reduce Routine Follow-up Head Imaging in Complicated Mild Traumatic Brain Injury

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Authors: Stippler, Martina, Nelton, Emmalin, Keith, Stacey, Rosen, Carlo
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01-12-2020
• Subjects: Brain surgery; Medical imaging; Neurosurgery; Surgical techniques; Traumatic brain injury
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_479

INTRODUCTION Routine follow-up head imaging in complicated mild traumatic brain injury (cmTBI) patients has not been shown to alter treatment, improve outcomes, or identify patients in need of neurosurgical intervention. We developed a follow-up head CT triage algorithm for cmTBI patients to decrease the number of routine follow-up head CT scan obtained in this population. METHODS Data on all cmTBI patients presenting from July 1, 2018, to June 31, 2019, to our level 1, tertiary, academic medical center were collected prospectively and analyzed retrospectively. Descriptive analysis was performed. RESULTS Of the 178 patients enrolled, 52 (29%) patients received a follow-up head CT. Of these, 15% (n = 27) of patients were scanned because of initial presentation and triage to the group to receive a routine follow-up head CT. Of the 151 patients who were triaged to the group without routine follow-up head CT scan, there was an 88.74% 9 (n = 151) protocol adherence. There were 17 violations of the protocol. CONCLUSION Utilizing this protocol, we were able to safely decrease the use of routine follow-up head CT scans in cmTBI patients by 71% without any missed injuries or delayed surgery. Adoption of the protocol was high among all services managing TBI patients.