Original article Role of repeat CT scans in the management of traumatic brain injury Ramesh S. Doddamani a , Sunil K. Gupta a, *, Navneet Singla a , Sandeep Mohindra a , Paramjeet Singh b a Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India b Department of Radio-diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India article info Article history: Received 12 March 2012 Accepted 8 April 2012 Available online 19 April 2012 Keywords: Change in management Intracranial lesions Traumatic brain injury Serial CT scans abstract Background: In trauma practice, there are no guidelines on the necessity or value of repeat CT scan. The purpose of the present study was to determine the role of serial CTs in demonstrating changes in intracranial lesions and the influence on management. Methods: In this study, 201 patients of traumatic brain injury were followed with serial CT scans for a maximum of up to 5 scans. The presence of different types of intracranial lesions at each CT scan as well as the evolution of lesions was recorded. The development of new lesions was noted. The management decisions at the time of each CT was detailed. Results: Progression of lesion was seen most often in patients with mixed lesions (21.8%). New lesions were seen in 5.5% of patients at CT-2 and in 5.8% at CT-3. Out of total 201 patients, 47 (23%) had change in management. 26 (55%) decisions of change in manage- ment were based upon clinical deterioration and 21 (45%) upon radiological changes only. A higher incidence of surgical intervention was seen in patients who had the first CT scan within 6 h of initial trauma. However, a few patients in whom the first CT scan was 6 h after trauma as well as some patients in whom CT scan was repeated as a routine without any clinical deterioration also had a change in their management. Conclusions: Repeat CT scans resulted in management changes even in patients with no clinical deterioration and thus may be of value in detecting changes at an early stage. Copyright ª 2012, Neurotrauma Society of India. All rights reserved. 1. Introduction In current trauma practice, a computed tomography (CT) scan is the initial study of choice to determine the type, extent and severity of traumatic brain injury as well as to determine the management protocol. However, there are no guidelines on the necessity or the value of repeat CT scan. There are reports emphasizing the importance of serial CT scans in patients with head trauma. 1e4 while others feel it to be unnecessary in most patients. 5e7 The purpose of the present study was to determine whether serial CT scans demonstrated significant change from the findings in the first CT scan and whether repeat scans had influence on management options. * Corresponding author. E-mail address: drguptasunil@gmail.com (S.K. Gupta). Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/ijnt the indian journal of neurotrauma 9 (2012) 33 e39 0973-0508/$ e see front matter Copyright ª 2012, Neurotrauma Society of India. All rights reserved. doi:10.1016/j.ijnt.2012.04.007