gms | German Medical Science

Objective: Secondary brain injury following severe traumatic brain injury (TBI) likely significantly contributes to overall TBI outcome. Perfusion deficits are thought to play an important role; these are at least partly triggered by local or global ICP increase. Perfusion-CT (PCT) is already established as an objective and sensitive examination tool to asses overall and local brain perfusion. We sought to determine the benefit of Perfusion-CT as an initial diagnostic tool after TBI in an emergency room setting suitable to support therapeutic decisions.

Methods: We introduced the use of Perfusion-CT as part of our standard diagnostic protocol after TBI. We prospectively analyzed every patient above 18 years of age in a 9-month period (January through September 2016) after TBI and a Glasgow Coma Scale (GCS) ≤ 8.The PCT was obtained right after the non-contrast CT scan of the head and before the following diagnostics of the cervical spine and whole body scan.

Results: From the 42 patients evaluated, 28 were male and 14 female. Mean age was 57.4 years. Median GCS was 3. A total of 17 patients (40.5%) had an acute subdural hematoma (aSDH), 10 (23.8%) had cerebral contusions, 1 (2.4%) had an epidural hematoma, 7 (16.7%) had a concussion, 4 (9.5%) had traumatic subarachnoid hemorrhage and 3 (7.1%) an intraparenchymal hemorrhage. None of the patients presented adverse events due to the contrast agent. Delays in therapeutic decision were not considered significant by the local joint trauma team. A significant increase in mean transit time (MTT) was observed comparing the injured hemisphere with less/non-injured hemisphere in the whole population investigated (40.8 ds vs. 36.2 ds, p=0.26). When comparing different pathologies this effect was only seen in aSDH (48.5 ds vs. 36.8 ds, p = 0.028). None of the other perfusion parameters did show significant differences.

Conclusion: Perfusion-CT as an initial diagnostic tool after TBI seems to be safe, efficient and feasible method to obtain additional information of brain tissue at risk in these patients. In aSDH a clear increase in MTT on the effected hemisphere is observed. The ongoing detailed analysis of the perfusion changes observed might improve pathophysiological understanding and decision making in trauma care.