Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey

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Lagares Gomez-Abascal, Alfonso and Castaño León, Ana María and Richard, Marion and Tsitsopoulos, Parmenion Philip and Morales, Julian and Mihai, Podaru and Pavlov, Vladislav and Mejan, Odile and Cruz, Javier de la and Payen, Jean François and Maignan, Maxime and Jacquin, Laurent and Douplat, Marion and Laribi, Said and Pes, Philippe and Ray, Patrick and Guenezan, Jérémy and Sebbane, Mustapha and Balen, Frédéric and Durand, Guillaume and Abric, Cordelia and Lorca, María Teresa and Ponce, Mariana Garcia and Cuesta, Maite and Alén, Jose A. F. (2022) Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey. European Journal of Trauma and Emergency Surgery . ISSN 1863-9933

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Official URL: https://doi.org/10.1007/s00068-022-01902-5



Abstract

Purpose: Clinical guidelines have been developed to standardize the management of mild traumatic brain injury (mTBI) in the emergency room, in particular the indication of brain CT scan and the use of blood biomarkers. The objective of this study was to determine the degree of adherence to guidelines in the management of these patients across four countries of Southern Europe.
Methods: An electronic survey including structural and general management of mTBI patients and six clinical vignettes was conducted. In-charge physicians from France, Spain, Greece and Portugal were contacted by telephone and email. Diferences among countries were searched using an unconditional approach test on contingency tables.
Results: One hundred and eighty eight physicians from 131 Hospitals (78 Spain, 36 France, 12 Greece and 5 Portugal) completed the questionnaire. There were diferences regarding the in-charge specialist across these countries. There was variability in the use of guidelines and their adherence. Spain was the country with the least guideline adherence. There was a global agreement in ordering a brain CT for patients receiving anticoagulation or platelet inhibitors, and for patients with seizures, altered consciousness, neurological defcit, clinical signs of skull fracture or signs of facial fracture. Aging was not an indication for CT in French centres. Loss of consciousness and posttraumatic amnesia were considered as indications for CT more frequently in Spain than in France. These fndings were in line with the data from the 6 clinical vignettes. The estimated use of CT reached around 50% of mTBI cases. The use of S100B is restricted to fve French centres.
Conclusions: There were large variations in the guideline adherence, especially in the situations considered to order brain CT after mTBI.


Item Type:Article
Additional Information:

CRUE-CSIC (Acuerdos Transformativos 2022)

Uncontrolled Keywords:Mild traumatic brain injury, Adult, Computed tomography, Clinical guidelines, Survey
Subjects:Medical sciences > Medicine > Neurosciences
ID Code:72568
Deposited On:27 May 2022 07:45
Last Modified:27 May 2022 09:52

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