After minor head injury, repeat CT scans do more harm than good

Wednesday, March 06, 2013 by: David Gutierrez, staff writer
Tags: CT scans, medical harm, head injuries

(NaturalNews) Once a computed tomography (CT) scan has shown brain bleeding caused by a minor head injury, further CT scans provide little to no medical benefit, according to a study conducted by researchers from McMaster University and published in the journal Neurosurgery. Nevertheless, such second scans are standard medical practice.

"The available evidence indicates that it is unnecessary to schedule a repeat CT scan after mild head injury when patients are unchanged or improving neurologically," the researchers wrote.

Because bleeding in the brain can be life threatening, doctors regularly use followup CT scans to monitor the condition of patients in which this condition has been detected, even when the injury that caused the condition was fairly minor. Yet each CT scan exposes the patient to potentially cancer-causing radiation, and also comes at a high financial cost.

"Although CT scanners are very useful tools, in an era of diminishing resources and a need to justify medical costs, this practice needs to be evaluated," the researchers wrote.

Scans provide little benefit

To determine whether repeated CT scans were medically helpful, the researchers reviewed the trauma database from their hospital, finding 445 cases of adults who had shown signs of intracranial hemorrhage following a minor head injury. The researchers found that 25 of these patients (5.6 percent) required further treatment following a second CT scan; in most cases, this treatment consisted of surgery to relieve the pressure on the brain. Of the 25 patients, all but two showed changes in their neurological condition that indicated a need for treatment; only two of the patients were referred to further treatment based on evidence from the CT scan alone. Neither of these patients needed surgery (they were prescribed a drug instead).

The researchers then expanded their investigation by conducting a meta-analysis that combined their initial data with that from 15 prior studies, for a total sample size of 2,693 patients. In this case, they found that while 2.7 percent of patients were referred to further treatment based on neurological changes, only 0.6 percent were referred to further treatment based on a CT scan alone.

This suggests that repeated CT scans provide little benefit beyond psychological reassurance, the researchers suggested.

"Although the radiological evidence in addition to clinical stability obtained from repeat imaging that rules out possible secondary changes is an assuring factor for the managing physician and the patient, a common clinical practice cannot be based on this reassurance alone," they wrote.

"In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks."

The researchers concluded that in patients with minor head injuries, neurological monitoring remains the most effective way to identify the need for further treatment. The findings do not apply to cases of severe head injury, however.

"Considering our hypothesis that the neurological examination is a better and risk-free indicator of intervention," they wrote, "we excluded the population of patients with moderate and severe head injuries because monitoring these groups is more difficult and less sensitive."

(Natural News Science)

Sources for this article include:http://www.eurekalert.org/pub_releases/2013-01/wkh-nnf010313.php ; http://www.news-medical.net