Evaluating the Utility of Repeat CT Scans in Patients with Isolated Mild Traumatic Subarachnoid Hemorrhage.

BACKGROUND AND OBJECTIVES: Traumatic subarachnoid hemorrhage (tSAH) is a common consequence of head trauma. Treatment of tSAH patients commonly involves serial CT imaging to assess for expansile hemorrhage. However, growing evidence suggests that these patients rarely deteriorate or require neurosurgical intervention. We assessed the utility of repeat CT imaging in adult patients with isolated tSAH and an intact initial neurologic exam.

METHODS: Patients presenting to Mass General Brigham Hospitals with tSAH between 2000 and 2021 were eligible for inclusion in this retrospective cohort study. Patients were excluded if their SAH was non-traumatic, they experienced another form of intracerebral hemorrhage, or if they had a documented Glasgow Coma Score (GCS) of 12 or lower and/or poor presenting neurological exam. Univariate and multivariate regression models were used for statistical analysis.

RESULTS: Overall, 405 patients were included (191 male). The most common mechanism of trauma was fall from standing (58%). The mean number of total CTs for all patients was 2.3, with 329 patients (80%) receiving two or more. 309 patients presented with no significant neurological symptoms. No patients developed acute neurologic deterioration or required neurosurgical intervention related to their bleed, although five had mild hemorrhagic expansion on follow up imaging.

CONCLUSION: In the present study, repeat imaging rarely demonstrated meaningful hemorrhagic expansion in this cohort of neurologically intact patients with isolated tSAH. In these patients with mild TBI, excessive CT imaging is perhaps unlikely to affect patient management and may present unnecessary burden to patients and hospital systems.