Indications for repeated computed tomography after mild traumatic brain injury with intracranial haemorrhage.

INTRODUCTION

Traumatic brain injury (TBI) with intracranial haematoma and a Glasgow Coma Scale (GCS) score ≥ 13 is classified as complicated mild TBI (mTBI). Patients are often admitted for observation, and some undergo repeated brain CT (CTc), though the need for routine repeated imaging remains debated. This study examined the prevalence and indications for repeated CTc in complicated mTBI at a single neurosurgical centre.

METHODS

This was a retrospective review of adult patients admitted between April 2022 and December 2024 with complicated mTBI. The exclusion criteria were immediate surgery, a GCS score less-than 13, age less-than 18 years or interdepartmental transfer. Data collected included demographics, comorbidities, antithrombotic/anticoagulant therapy, repeated CTc indications, radiographic progression, neurosurgical intervention, discharge status and 30-day mortality. Descriptive statistics were applied.

RESULTS

Among 127 patients, 94 (74.0%) underwent repeated CTc; 64.9% were routine or had undocumented documentation. Radiographic progression was more frequent in cases with documented clinical indication (39.5% versus 18.0%). Neurosurgical intervention was performed in three patients (2.4%), all following clinical deterioration; no intervention was based solely on routine CTc.

CONCLUSIONS

Routine repeated CTc in neurologically stable patients with complicated mTBI rarely alters management. Clinical deterioration, rather than radiological progression alone, dictated intervention. Repeated CTc should be reserved for patients with worsening neurological status, potentially reducing unnecessary resource use and radiation exposure.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.