Benefits of repeated CT scan in patients with neurosurgical-neurological problems in intensive care − retrospective analysis

Abstract

Introduction: CT examination of the brain is an integral part of neurointensive care. The examination, however, represents a risk for patients and has side effects. Indications for the procedure should therefore be carefully considered. The aim of the study was to analyze the indications for brain CT and the influence of its result on further treatment.
Method: A retrospective analysis of CT examinations of the brain performed during 2010 in 263 patients admitted to neurointensive care. The study assessed whether the indication for a CT scan was due to a change in the patient’s neurological status or routine, and also whether pharmacological sedation was used. Implications of the CT scan results for the course of treatment were evaluated.
Results: 763 CT examinations of brain were performed in the study group. 81% of the patients were under pharmacological sedation at the time of the exam indication, 19% had no sedation and could be clinically evaluated. In both groups, 80% of examinations were indicated on a routine basis. More than half of all CT examination results were evaluated as no change or improvement. Two thirds of them had no impact on the course of further treatment. Results of CT scans indicated due to a change in neurological status led to a change of therapy more often than in routine indications (24.8 vs. 14.2%). The difference was even greater in patients indicated for surgery (19 vs. 8.4%).
Conclusion: CT scans of the brain are and will continue to be a fundamental part of neurointensive care but cannot replace clinical examination, which is influenced by pharmacological sedation. Results of brain CT scans have led to a change in the course of therapy more frequently when indicated due to a change in neurological status. Rational indication of sedation can contribute to rational indication for brain imaging.