Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 49; no. 3; pp. 1189 - 1198
• Main Authors: Lagares, Alfonso, Castaño-Leon, Ana María, Richard, Marion, Tsitsopoulos, Parmenion Philip, Morales, Julian, Mihai, Podaru, Pavlov, Vladislav, Mejan, Odile, de la Cruz, Javier, Payen, Jean François
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2023; Springer Nature B.V; Springer Verlag
• Subjects: Brain - diagnostic imaging; Brain Concussion - diagnostic imaging; Clinical practice guidelines; Consciousness; Critical Care Medicine; Emergency medical care; Emergency Medicine; Europe; Fractures; Humans; Intensive; Life Sciences; Medical imaging; Medicine; Medicine & Public Health; Original; Original Article; Skull Fractures; Sports Medicine; Surgery; Surgical Orthopedics; Tomography, X-Ray Computed; Traumatic brain injury; Traumatic Surgery; Europe; Greece; France; Portugal; Spain; Clinical guidelines; Adult; Survey; Mild traumatic brain injury; Computed tomography
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-022-01902-5

Purpose
Clinical guidelines have been developed to standardize the management of mild traumatic brain injury (mTBI) in the emergency room, in particular the indication of brain CT scan and the use of blood biomarkers. The objective of this study was to determine the degree of adherence to guidelines in the management of these patients across four countries of Southern Europe.
Methods
An electronic survey including structural and general management of mTBI patients and six clinical vignettes was conducted. In-charge physicians from France, Spain, Greece and Portugal were contacted by telephone and email. Differences among countries were searched using an unconditional approach test on contingency tables.
Results
One hundred and eighty eight physicians from 131 Hospitals (78 Spain, 36 France, 12 Greece and 5 Portugal) completed the questionnaire. There were differences regarding the in-charge specialist across these countries. There was variability in the use of guidelines and their adherence. Spain was the country with the least guideline adherence. There was a global agreement in ordering a brain CT for patients receiving anticoagulation or platelet inhibitors, and for patients with seizures, altered consciousness, neurological deficit, clinical signs of skull fracture or signs of facial fracture. Aging was not an indication for CT in French centres. Loss of consciousness and posttraumatic amnesia were considered as indications for CT more frequently in Spain than in France. These findings were in line with the data from the 6 clinical vignettes. The estimated use of CT reached around 50% of mTBI cases. The use of S100B is restricted to five French centres.
Conclusions
There were large variations in the guideline adherence, especially in the situations considered to order brain CT after mTBI.