MRI Head with DTI There is no relevant literature to support the use of DTI in the short-term follow-up imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the short-term follow-up imaging evaluation of acute head trauma. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the short-term follow-up imaging evaluation of acute head trauma. CT Head In the presence of an abnormal initial CT and in the absence of neurologic deterioration, the decision to perform a routine repeat CT should depend on the estimated risk for subclinical progression of intracranial findings. A large systematic review and meta-analysis of 41 studies enrolling 10,501 patients with TBI suggested there is overutilization of repeat CT, which changed management in only 11.4% of patients across prospective studies and 9.6% of patients across retrospective studies (2.3% and 3.9% in a subgroup analysis of patients with mild TBI) [40]. Head Trauma Routine follow-up CT after an abnormal initial CT is supported for moderate to severe TBI and for anticoagulated patients [2]. Patients on anticoagulant or antiplatelet medication had a 3-fold increase in frequency of bleeding progression on repeat head CT (26% versus 9%) in one retrospective analysis of 508 CT-positive TBIs [41]. For patients with mild TBI and positive CT (who are not on anticoagulation), the appropriateness of routine repeat CT may depend on the size and type of intracranial findings. A retrospective review of 321 patients with mild TBI with ICH on initial CT found imaging progression in only 6% (and neurologic deterioration in only 1%). Subfrontal/temporal parenchymal contusion and volume of ICH >10 mL were imaging predictors of progression (use of anticoagulation and >65 years of age were clinical predictors).
Head Trauma PCAs. MRI Head with DTI There is no relevant literature to support the use of DTI in the short-term follow-up imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the short-term follow-up imaging evaluation of acute head trauma. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the short-term follow-up imaging evaluation of acute head trauma. CT Head In the presence of an abnormal initial CT and in the absence of neurologic deterioration, the decision to perform a routine repeat CT should depend on the estimated risk for subclinical progression of intracranial findings. A large systematic review and meta-analysis of 41 studies enrolling 10,501 patients with TBI suggested there is overutilization of repeat CT, which changed management in only 11.4% of patients across prospective studies and 9.6% of patients across retrospective studies (2.3% and 3.9% in a subgroup analysis of patients with mild TBI) [40]. Head Trauma Routine follow-up CT after an abnormal initial CT is supported for moderate to severe TBI and for anticoagulated patients [2]. Patients on anticoagulant or antiplatelet medication had a 3-fold increase in frequency of bleeding progression on repeat head CT (26% versus 9%) in one retrospective analysis of 508 CT-positive TBIs [41]. For patients with mild TBI and positive CT (who are not on anticoagulation), the appropriateness of routine repeat CT may depend on the size and type of intracranial findings. A retrospective review of 321 patients with mild TBI with ICH on initial CT found imaging progression in only 6% (and neurologic deterioration in only 1%). Subfrontal/temporal parenchymal contusion and volume of ICH >10 mL were imaging predictors of progression (use of anticoagulation and >65 years of age were clinical predictors).