Follow-up computed tomography imaging in patients who have suffered traumatic brain injury in Zimbabwe

Abstract

Introduction: Traumatic brain injury (TBI) is frequently associated with mortality and morbidity in low-income countries. Computed Tomography Brain (CTB) imaging aid in the management of patients by accurately exploring primary and secondary brain injuries following trauma. However, there is controversy among researchers on the benefits of follow-up CTB imaging (FCTBI) amongst patients presenting with TBI showing a normal baseline scan. As such, in an attempt to address the contention, the primary focus of this research study was to explore the role of FCTBI with regards to the clinical status of such patients. The secondary focus was to determine the timing of performing FCTBI post TBI. Method: A retrospective cross sectional quantitative design was conducted for this research study. A total sampling strategy was employed on medical records of 85 patients treated at the research site in Zimbabwe. Data were collected over a two year period. Adult patients between the ages of 18 and 75, with TBI and who had a normal first CTBI1 (primary scan done upon hospital admission) were included in this research study. The evolution of different types of brain pathology diagnosed on FCTBI in affected patients were recorded on data collection sheets. An analysis then followed to establish whether the sample patients had developed any neurological complications. Results: The study showed that in 85 patients with TBI, 36% recorded abnormal radiological findings on FCTBI with subdural haematoma (19%) being the most common intracranial lesion followed by intracerebral haemorrhage (8%), subarachnoid haemorrhage (6%) and lastly, pneumocephalus and epidural haematoma (1% respectively). The most frequent causal mechanism of trauma was road traffic accidents (RTAs) at 58%. Males with TBI comprised a higher proportion (53%) than did females (47%). The performance of CTBI1 at 8 hours post trauma occurrence, within a recommended hospital observation period of 20 hours post trauma occurrence, may provide sufficient time for lesions to evolve and thus determine the appropriate patient management. The young adult age group of 26-35 years was found to be more susceptible to TBI. Conclusion: FCTBI was found to be of value in timely detection of evolving intracranial lesions which enabled appropriate management of patients. The current study recommends that patients who exhibit a declining Glasgow Coma Scale (GCS) score and deteriorating neurological status undergo a FCTBI.