Neurocrit Care. 2017 Feb;26(1):87-95. doi: 10.1007/s12028-016-0291-5.

Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients.
 

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Supplement:

This research provides a novel risk/benefit analysis of a frequent but understudied procedure, namely repeated computed tomography after severe traumatic brain injury (TBI).

While available evidence from the literature suggests that benefits are limited, especially when imagery data is decoupled from the clinical context as well as from the multimodal monitoring data,1,2 heuristical evidence suggests that there are a number of undesirable effects related to the transport of the patient.

The primary goal of this study was to relate the potential immediate and delayed risks associated with intrahospital transport and to evaluate for the therapeutic benefit of RCT in such severe TBI patients.

To evaluate for the risk/benefit ratio associated with RCT after TBI, we firstly evaluated the risks of such a practice. Our results demonstrated that intrahospital transport for head CT scanning carried significant secondary insults and adverse events in severe TBI patients.3

We observed that medical treatment changes were mainly driven by multimodal monitoring data evolution rather than based upon imaging CT new findings. When combining and increased risk (secondary insults and adverse events during intra-hospital transport) with a low benefit (CT imaging new findings-induced treatment changes), the ratio is probably not favorable to strict repeated computed tomography procedure application.

Looking ahead, our next goal will be to evaluate the therapeutic benefit of “any” control CT-scan after TBI. Indeed, with the exception of mild traumatic brain injury for which clinical neurological surveillance remains reliable, there is, to the best of our knowledge, no evidence that systematic control CT scans are beneficial to optimally treat severe TBI patients. To address this question, a multicenter trial including a large number of patients recruited by hospitals applying homogeneous TBI care is requested.

 

References: 

1- Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: does it benefit patients. J Trauma. 2004;56:475–80 discussion 480–481.
2- Chao A, Pearl J, Perdue P, Wang D, Bridgeman A, Kennedy S, et al. Utility of routine serial computed tomography for blunt intracranial injury. J Trauma. 2001;51:875–6 discussion 875–876.
3- Martin M, Cook F, Lobo D, Vermersch C, Attias A, Ait-Mamar B, Plaud B, Mounier R, Dhonneur G. Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients. Neurocrit Care. 2017 Feb;26(1):87-95.
 
Figure 1: The authors with other team members.  From left: Paul-Henri JOST, Roman MOUNIER, Mathieu MARTIN, Cécile REBIERE, Gilles DHONNEUR, Séverine COUFFIN, Arié ATTIAS, David LOBO & Fabrice COOK.