In patients with traumatic intracranial pathologies applying to the emergency department; effect of control tomography on finish

Traumatic brain injury is a serious health problem worldwide. It causes significant death and permanent disability. Computed tomography (CT) combined with physical examination is the primary diagnostic method for the evaluation of traumatic brain injury. However, CT is an imaging method in which high amounts of X-rays are applied, causing radiation exposure. For this reason, some criteria have been established for brain CT in order not to give unnecessary radiation to the patient, to prevent unnecessary medical expenses and inappropriate referrals. Repetitive CT scans can also be performed for control purposes during the follow-up of patients in the emergency department, mostly due to clinical habits. A review of the literature reveals that this approach is controversial. CBT requested for the patient who does not need CBT; It has been associated with losses such as loss of workforce, increased cost, unnecessary radiation exposure. In our study, it was aimed to compare the first and control tomography of patients with pathology and to determine the effect of control tomography on the outcome and the necessity of control tomography. This study was carried out in Aydın Adnan Menderes University Faculty of Medicine, Department of Emergency Medicine. All patients who applied to the emergency department with head trauma between 01.01.2019 and 01.10.2022 and had brain CT for control purposes in the emergency department were included in our study within the framework of inclusion criteria. As a data collection tool, a 14-question case report form prepared by the researcher, developed in line with the relevant literature, was used. Research data were evaluated using SPSS 21.0 statistical program. For statistical significance, the p value was determined to be less than 0.05. A total of 237 patients with isolated head trauma, 51 (21.5%) female and 186 (78.5%) male, were included in our study. It was determined that 27.0% (n=64) of the patients were in the pediatric age group, 54.0% (n=128) were adults, and 19.0% (n=45) were in the geriatric age group. Intracranial lesion was detected in 65.8% (n=156) of the patients. 48.1% (n=75) SAH, 23.7% (n=37) intraparenchymal hemorrhage, 19.9% (n=31) subdural hemorrhage, 8.3% of those with intracranial lesions It was determined that epidural bleeding developed in 3 (n=13). Additional injury was observed in 36.7% (n=87) of the patients. As additional injuries, the most common thoracic injury (n=34, 39.1%), the second most common multiple injury (n=31, 35.6%), and the third most common extremity injury (n=18, 20.7%) it has been detected. 68.4% (n=162) of the patients were hospitalized, 23.2% (n=55) were discharged, 8.0% (n=19) underwent surgery, 0.4% ( n=1) was found to be dead. The median GCS at admission was 15.0 (1.0), and the median value for control GCS was 15.0 (1.0), and no statistically significant difference was found between the admission and control GCS. Control CT was based on the time after the first CT was taken; It was determined that the median was 6.0 (2.0) hours later. The median time of CT scan was 6.0 (2.0) in the pediatric age group, 6.0 (2.0) in the adult age group, and 6.0 (1.0) in the geriatric age group. No statistically significant relationship was found in terms of time. When we look at the literature studies; It is seen that clinical worsening rates are low, discharge rates are high, and the time required for control CT is much higher than in our study in patients who underwent control CT. In our study, the rate of clinical worsening was found to be low, in line with the literature, and the time required for discharge rate and control CT scan was found to be low, contrary to the literature. This result, which is inconsistent with the literature, shows that patients who come to the emergency department with head trauma and undergo CT scan, regardless of neurological deterioration, have control CT. Considering the fact that the clinical management of patients whose hospitalization or discharge decision is prolonged in the emergency department conditions is far from optimal, the costs increase with additional examinations, and the workload of healthcare professionals, which is already quite high, increases, we think that it will be beneficial to be more selective when making control CT requests in patient management.