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The need for immediate computed tomography scan after emergency craniotomy for head injury. J Trauma 2008 Feb;64(2):326-33; discussion 333-4

Date

02/28/2008

Pubmed ID

18301194

DOI

10.1097/TA.0b013e318163358a

Scopus ID

2-s2.0-43149102281   5 Citations

Abstract

BACKGROUND: Patients who undergo emergency craniotomy for head injury require vigilant postoperative (postop) care to obtain the best possible outcome. Although repeat head computed tomography (CT) scans are a key component of the management of these patients, there is no consensus on the optimal timing of the initial postop CT.

METHODS: We conducted a retrospective registry-based review of the care of 199 consecutive trauma patients who underwent craniotomy for head injury at a Level I trauma center to evaluate the role of postop CT in their management.

RESULTS: One hundred and ninety-nine patients underwent 218 craniotomies for head injury during the 78-month study period. Mean age was 48 years and 73.9% were men. Overall survival was 71.4%. The primary indication for operation included subdural hematoma (SDH) in 136 (62.4%), epidural hematoma (EDH) in 32 (14.7%), intraparenchymal hemorrhage or contusion in 21 (9.6%), depressed skull fracture in 17 (7.8%), and other indications in 12 (5.5%). Postop CTs were obtained after 197 (90.4%) of the operations at a mean of 19.2 hours and revealed a variety of unexpected findings with clinical implications. The only variable statistically associated with unexpected findings was SDH as an indication for operation (p < 0.01). Fourteen (7.0%) patients required a second craniotomy in the 2 days after their initial operation. In six (3.0%) patients, postop CTs were obtained between 4.2 hours and 21.1 hours after initial craniotomy and an earlier postop CT would most likely have prevented a significant delay in operation. Findings in these six patients included recurrent SDH or EDH in two, new SDH or EDH in two, and intraparenchymal hemorrhage in two. Neither neurologic examination nor postop intracranial pressure monitoring reliably predicted the presence of new or recurrent hemorrhage or other significant findings.

CONCLUSION: Early, if not immediate, postop CT after emergency craniotomy for head trauma appears to be warranted. We found a significant incidence of unexpected findings on postop CT and encountered avoidable delays in treatment of new or recurrent findings.

Author List

Paci GM, Sise MJ, Sise CB, Sack DI, Swanson SM, Holbrook TL, Hunstock AM, Altenau LL, Carver TW

Author

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Abbreviated Injury Scale
Craniocerebral Trauma
Craniotomy
Emergency Treatment
Female
Hematoma
Humans
Intracranial Hemorrhages
Male
Middle Aged
Postoperative Care
Retrospective Studies
Tomography, X-Ray Computed
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3