The Importance of CT Scans in Traumatic Brain Injuries

According to the Centers for Disease Control and Prevention (CDC), there were approximately 61,000 Traumatic Brain Injury (TBI)-related deaths in the United States in 2019, translating to an average of 166 deaths a day. Not only can the initial brain injury prove fatal, people suffering from a TBI may also experience a wide range of physical or cognitive symptoms that develop days or even weeks later.

A TBI is defined as a violent blow or jolt to the head or in some cases, the body. TBIs can also be caused by an object piercing brain tissue, such as a bullet or shattered piece of skull. TBI is also a leading cause of disability in the U.S., with researchers estimating that 3.2 million–5.3 million Americans are living with a TBI-related disability.

Who is at Risk for TBIs?

The most common activities leading to a TBI are falls, vehicle-related collisions, firearm-related injury, violence, sports injuries, and explosive blasts or combat injuries. While anyone can experience a TBI, there are some populations statistically more affected by TBI, including:

• Children, especially newborns to 4-year-olds
• Young adults, especially those between ages 15 and 24
• Adults age 60 and older
• Males in any age group

Additionally, research shows that people in certain social environments are also more at risk for TBIs, including:

• Racial and ethnic minorities (particularly American Indian/Alaska Natives with contributing factors include higher rates of motor vehicle crashes, substance use, difficulties in accessing healthcare, and more)
• Service members and Veterans
• People who experience homelessness
• People who are in correctional and detention facilities
• Survivors of intimate partner violence
• People living in rural areas

Learn more about contributing factors for the disparities in rates here.

Why is a Timely CT scan important for TBI?

Once a TBI is confirmed, it’s important to order a CT scan as soon as possible to ensure proper treatment can begin immediately. Patients with a TBI diagnosis are more likely to have time-sensitive injuries like bleeding in the brain and skull fracture, and a timely CT scan can help quickly identify these issues.

Patients with TBIs are also at a higher risk of a venous thromboembolism (VTE) with rates as high as 20-30%. The American College of Surgeons Trauma Quality Improvement Program (TQIP) recommends earlier administration of pharmacologic prophylaxis for VTEs (within the first 72 hours) for patients who have a stable repeat head CT scan and are at low risk for progression of intracranial bleeding.

CT scans and TBI in Practice

ESO recently introduced its inaugural ESO Trauma Index, a review similar to its EMS Index and Fire Service Index. Based on data from nearly 600 participating hospitals, and representing more than 802,000 patient records from 2020, the Trauma Index helps trauma programs identify where they are in alignment with national data and where opportunities for improvement or further assessment exist. The index also includes best practices and recommendations for the key areas covered.

Among the seven key metrics included in the ESO Trauma Index are data on “Time to Head CT for Patients with TBI.” Based on data in the Index, 99% of patients with confirmed TBI who received a CT scan received it within 24 hours of arrival at the ED. By the 72-hour mark, 100% of TBI patients who were prescribed a CT scan had completed the scan.

However, the data also show that 22% of patients with a confirmed TBI diagnosis did not receive a CT scan at all. This may seem like a small percentage but considering the importance of quick action following confirmation of a TBI diagnosis, these numbers indicate that there is room for improvement in this metric.

CT scans are vital to accurately detecting TBI-related issues like intracranial hemorrhages that require immediate neurosurgical action to ensure the best outcome possible for the patient. Repeat CT scans can also lower the risk of administering prophylaxis to decrease the VTE by helping ensure the injury has stabilized.

Minor Head Injury Trauma and CT Scans

While CT scans are crucial in assessing major TBI, their use is more controversial in assessing patients with minor head injury trauma like concussions. Unnecessary CT scans can increase the cost of care, increase the amount of time needed to treat patients, and crowd EDs and radiology departments.

Clinicians should carefully assess whether a CT scan is needed when evaluating patients with mild head injury trauma. The CDC guidelines for Mild Traumatic Brin Injury can be especially helpful for clinicians in acute settings like the ED.

More Trauma Insights

For more trauma insights and best practices based on industry data, download the ESO Trauma Index today.