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Correlation and Cost Effectiveness of Repeat Head CT vs. Changes in Neurological Status in Pediatric Traumatic Brain Injuries. Does it Change Patient Management?
Elizabeth Lulaj, MD, Moheb Said, MD, Mitchell Price, MD

Traumatic brain injury (TBI) is a very common component of pediatric trauma and results in an estimated 80% of pediatric traumatic brain deaths. Our study sought to determine whether repeat CT scan in the first 24 to 48 hours leads to change in management when performed on pediatric patients with TBI, and to assess the utility of monitoring neurological status in the use of repeat CT. Retrospective 10 year chart review of 201 pediatric patients <21 years old with traumatic brain injuries and positive head CT findings. Routine repeat head CT (RHCT) was defined as RHCT ordered in the following 24 to 48 hours irrespective of changes in the patient's neurologic condition. Neurologic change 105 cases (52%). No neurologic change 96 cases(48%). Repeat head ct (RHCT) 82 (78%), NO RHCT 23 cases (22%), RHCT 88 cases (92%), No repeat head CT 8 cases (8%), Worsening head CT 44 cases (54%), Sable head CT 38 cases (46%), Worsening head CT 0 cases, Change in management 6 cases (13%). In our institution routine repeat head CT in patients with out neurologic deterioration has proven to not be efficacious or cost effective. Results of repeat head CT should be correlated with the clinical status of the patient.


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