{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:45:59Z","timestamp":1774449959486,"version":"3.50.1"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The utility of routine repeat head CT (HCT) scans in the management of minimal head injury (MHI) patients with an intracranial hemorrhage (ICH) has been questioned in multiple studies. All these studies analyzed this by obtaining a repeat HCT study, and none examined the effects of eliminating these routine HCT studies in neurologically intact patients. The authors' institution implemented a new \u201cNeurologic Observation without Repeat HCT\u201d (NORH) protocol with no repeat HCT scanning for patients admitted for MHI and ICH whose neurological status was maintained or improved to a Glasgow Coma Scale score of 15 at 24 hours after admission. This purpose of this study was to assess the outcomes and safety of this novel protocol.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Records of patients who sustained blunt trauma MHI and an ICH and\/or skull fracture on initial HCT between January 1, 2009, and December 31, 2012, were retrieved from the trauma registry of a Level I trauma center. The authors analyzed 95 patients in whom the NORH protocol was followed. Outcome measures included death, emergency department readmission, neurosurgical intervention, delayed repeat HCT, and length of stay.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The NORH protocol was followed for 95 patients; 83% of the patients were male, the average age was 38 \u00b1 16.0 years old, and the most common cause of trauma was assault (35%). Of the 95 patients in whom the NORH protocol was followed, 8 (8%) had a delayed repeat HCT study (&gt; 24 hours) after admission, but none resulted in neurosurgical intervention because of progression of ICH. The average length of stay was 4 \u00b1 7.2 days. None of the patients were readmitted to the hospital.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Implementation of the NORH protocol (eliminating routine follow-up HCT) resulted in very low rates of delayed neurological deterioration, no late neurosurgical interventions resulting from ICH progression, very few emergency department revisits, and no readmissions. For a select group of MHI patients with ICH, the NORH protocol is safe and effective, and can reduce radiation exposure and costs.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.9.jns151379","type":"journal-article","created":{"date-parts":[[2016,1,16]],"date-time":"2016-01-16T00:49:00Z","timestamp":1452905340000},"page":"667-673","source":"Crossref","is-referenced-by-count":23,"title":["Eliminating unnecessary routine head CT scanning in neurologically intact mild traumatic brain injury patients: implementation and evaluation of a new protocol"],"prefix":"10.3171","volume":"125","author":[{"given":"Seema P.","family":"Anandalwar","sequence":"first","affiliation":[{"name":"Departments of Trauma Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine Y.","family":"Mau","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chirag G.","family":"Gordhan","sequence":"additional","affiliation":[{"name":"Departments of Trauma Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Majmundar","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Meleis","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles J.","family":"Prestigiacomo","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad C.","family":"Sifri","sequence":"additional","affiliation":[{"name":"Departments of Trauma Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns151379","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1097\/TA.0b013e318265ccd9","article-title":"A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS score of 13 to 15","volume":"73","author":"AbdelFattah","year":"2012"},{"key":"b2-jns151379","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1227\/NEU.0b013e318276f899","article-title":"The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis","volume":"72","author":"Almenawer","year":"2013"},{"key":"b3-jns151379","series-title":"J Trauma","first-page":"1015","article-title":"Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury","volume":"66","author":"Bee","year":"2009"},{"key":"b4-jns151379","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1097\/01.TA.0000149492.92558.03","article-title":"Does routine serial computed tomography of the head influence management of traumatic brain injury? 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