{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:12:01Z","timestamp":1791385921960,"version":"4.3.3"},"reference-count":52,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Patients with mild traumatic brain injury (MTBI) with intracerebral hemorrhage (ICH), particularly those at higher risk of having ICH progression, are typically prescribed a second head Computer Tomography (CT) scan to monitor the disease development. This study aimed to evaluate the role of a repeat head CT in MTBI patients at a higher risk of ICH progression by comparing the intervention rate between patients with and without ICH progression. Methods: 192 patients with MTBI and ICH were treated between November 2019 to December 2020 at a single level II trauma center. The Glasgow Coma Scale (GCS) was used to classify MTBI, and initial head CT was performed according to the Canadian CT head rule. Patients with a higher risk of ICH progression, including the elderly (\u226565 years old), patients on antiplatelets or anticoagulants, or patients with an initial head CT that revealed EDH, contusional bleeding, or SDH &gt; 5 mm, and multiple ICH underwent a repeat head CT within 12 to 24 h later. Data regarding types of intervention, length of stay in the hospital, and outcome were collected. The risk of further neurological deterioration and readmission rates were compared between these two groups. All patients were followed up in the clinic after one month or contacted via phone if they did not return. Results: 189 patients underwent scheduled repeated head CT, 18% had radiological intracranial bleed progression, and 82% had no changes. There were no statistically significant differences in terms of intervention rate, risk of neurological deterioration in the future, or readmission between them. Conclusion: Repeat head CT in mild TBI patients with no neurological deterioration is not recommended, even in patients with a higher risk of ICH progression.<\/jats:p>","DOI":"10.3390\/ijerph192114311","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T03:36:44Z","timestamp":1667360204000},"page":"14311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression"],"prefix":"10.3390","volume":"19","author":[{"given":"Farizal","family":"Fadzil","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy Khor Cheng","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Tengku Ampuan Rahimah, Klang 41200, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azudin","family":"Mohd Khairy","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Tengku Ampuan Rahimah, Klang 41200, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5571-608X","authenticated-orcid":false,"given":"Anis Nabillah","family":"Mohd Azli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the Global Incidence of Traumatic Brain Injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_2","unstructured":"Clinical Practice Guidelines (CPG) (2015). Early Management of Head Injury in Adults."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1089\/neu.2013.2873","article-title":"Value of Repeat Head Computed Tomography after Traumatic Brain Injury: Systematic Review and Meta-Analysis","volume":"31","author":"Reljic","year":"2014","journal-title":"J. Neurotrauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.3171\/2009.5.JNS081369","article-title":"The Natural History of Brain Contusion: An Analysis of Radiological and Clinical Progression","volume":"112","author":"Alahmadi","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","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? A Prospective Evaluation","volume":"57","author":"Brown","year":"2004","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_6","first-page":"1605","article-title":"Utility of Repeat Head Computed Tomography in Patients With an Abnormal Neurologic Examination After Minimal Head Injury","volume":"71","author":"Sifri","year":"2011","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/01.TA.0000114304.56006.D4","article-title":"Routinely Repeated Computed Tomography after Blunt Head Trauma: Does It Benefit Patients?","volume":"56","author":"Kaups","year":"2004","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.amjsurg.2003.12.015","article-title":"Value of Repeat Cranial Computed Axial Tomography Scanning in Patients with Minimal Head Injury","volume":"187","author":"Sifri","year":"2004","journal-title":"Am. J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1177\/000313480607201204","article-title":"Utility of Neurosurgical Consultation for Mild Traumatic Brain Injury","volume":"72","author":"Huynh","year":"2006","journal-title":"Am. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1097\/01.ta.0000224225.54982.90","article-title":"A Prospective Evaluation of the Value of Repeat Cranial Computed Tomography in Patients With Minimal Head Injury and an Intracranial Bleed","volume":"61","author":"Sifri","year":"2006","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_11","first-page":"1339","article-title":"Indications for Routine Repeat Head Computed Tomography (CT) Stratified by Severity of Traumatic Brain Injury","volume":"62","author":"Brown","year":"2007","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"549","DOI":"10.3171\/2011.11.JNS111092","article-title":"Are Routine Repeat Imaging and Intensive Care Unit Admission Necessary in Mild Traumatic Brain Injury?","volume":"116","author":"Washington","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"667","DOI":"10.3171\/2015.9.JNS151379","article-title":"Eliminating Unnecessary Routine Head CT Scanning in Neurologically Intact Mild Traumatic Brain Injury Patients: Implementation and Evaluation of a New Protocol","volume":"125","author":"Anandalwar","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e000129","DOI":"10.1136\/tsaco-2017-000129","article-title":"Routine Repeat Head CT May Not Be Necessary for Patients with Mild TBI","volume":"3","author":"Rosen","year":"2018","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1089\/neu.2014.3808","article-title":"Traumatic Intracerebral Hemorrhage: Risk Factors Associated with Progression","volume":"32","author":"Cepeda","year":"2015","journal-title":"J. Neurotrauma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.annemergmed.2011.12.003","article-title":"Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol","volume":"59","author":"Menditto","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/TA.0000000000000725","article-title":"Delayed Intracranial Hemorrhage in the Anticoagulated Patient","volume":"79","author":"Miller","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7812\/TPP\/15-095","article-title":"Risk of Delayed Intracerebral Hemorrhage in Anticoagulated Patients after Minor Head Trauma: The Role of Repeat Cranial Computed Tomography","volume":"20","author":"Swap","year":"2016","journal-title":"Perm. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/01.TA.0000151671.35280.8B","article-title":"Effects of Antiplatelet Agents on Outcomes for Elderly Patients With Traumatic Intracranial Hemorrhage","volume":"58","author":"Ohm","year":"2005","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_20","first-page":"895","article-title":"The Value of Sequential Computed Tomography Scanning in Anticoagulated Patients Suffering From Minor Head Injury","volume":"68","author":"Kaen","year":"2010","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.amjsurg.2014.05.019","article-title":"Effect of Preinjury Warfarin Use on Outcomes after Head Trauma in Medicare Beneficiaries","volume":"208","author":"Collins","year":"2014","journal-title":"Am. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"109","DOI":"10.3171\/jns.2002.96.1.0109","article-title":"Progressive Hemorrhage after Head Trauma: Predictors and Consequences of the Evolving Injury","volume":"96","author":"Oertel","year":"2002","journal-title":"J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4103\/0028-3886.28109","article-title":"Expanding Traumatic Intracerebral Contusion\/Hematoma","volume":"54","author":"Yadav","year":"2006","journal-title":"Neurol. India"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1089\/neu.2007.0385","article-title":"Progression of Traumatic Intracerebral Hemorrhage: A Prospective Observational Study","volume":"25","author":"Narayan","year":"2008","journal-title":"J. Neurotrauma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ijnt.2012.04.007","article-title":"Role of Repeat CT Scans in the Management of Traumatic Brain Injury","volume":"9","author":"Doddamani","year":"2012","journal-title":"Indian J. Neurotrauma"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Servadei, F., Antonelli, V., Giuliani, G., Fainardi, E., Chieregato, A., and Targa, L. (2002). Evolving Lesions in Traumatic Subarachnoid Hemorrhage: Prospective Study of 110 Patients with Emphasis on the Role of ICP Monitoring. Intracranial Pressure and Brain Biochemical Monitoring, Springer.","DOI":"10.1007\/978-3-7091-6738-0_21"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00701-003-0207-y","article-title":"Time Course of CT Evolution in Traumatic Subarachnoid Haemorrhage: A Study of 141 Patients","volume":"146","author":"Fainardi","year":"2004","journal-title":"Acta Neurochir."},{"key":"ref_28","first-page":"508","article-title":"Early Progression of Traumatic Cerebral Contusions: Characterization and Risk Factors","volume":"67","author":"White","year":"2009","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1227\/NEU.0b013e318276f899","article-title":"The Value of Scheduled Repeat Cranial Computed Tomography After Mild Head Injury","volume":"72","author":"Almenawer","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_30","first-page":"1303","article-title":"The Effects of Clopidogrel on Elderly Traumatic Brain Injured Patients","volume":"65","author":"Wong","year":"2008","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"26","DOI":"10.13004\/kjnt.2014.10.1.26","article-title":"Serial Brain CT Scans in Severe Head Injury without Intracranial Pressure Monitoring","volume":"10","author":"Shin","year":"2014","journal-title":"Korean J. Neurotrauma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s12028-020-00994-4","article-title":"Contusion Progression Following Traumatic Brain Injury: A Review of Clinical and Radiological Predictors, and Influence on Outcome","volume":"34","author":"Adatia","year":"2021","journal-title":"Neurocrit. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1097\/00005373-200111000-00008","article-title":"Utility of Routine Serial Computed Tomography for Blunt Intracranial Injury","volume":"51","author":"Chao","year":"2001","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.TA.0000071295.67263.A2","article-title":"The Need for Head Computed Tomography in Patients Sustaining Loss of Consciousness after Mild Head Injury","volume":"55","author":"Falimirski","year":"2003","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/000313481408000123","article-title":"Repeat Head Computed Tomography in Anticoagulated Traumatic Brain Injury Patients: Still Warranted","volume":"80","author":"Joseph","year":"2014","journal-title":"Am. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1089\/neu.2013.3241","article-title":"Early Hemorrhagic Progression of Traumatic Brain Contusions: Frequency, Correlation with Coagulation Disorders, and Patient Outcome: A Prospective Study","volume":"31","author":"Juratli","year":"2014","journal-title":"J. Neurotrauma"},{"key":"ref_37","first-page":"42","article-title":"Hematoma Enlargement Among Patients with Traumatic Brain Injury: Analysis of a Prospective Multicenter Clinical Trial","volume":"8","author":"Qureshi","year":"2015","journal-title":"J. Vasc. Interv. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1177\/000313481708300514","article-title":"Repeat Head CT? Not Necessary for Patients with a Negative Initial Head CT on Anticoagulation or Antiplatelet Therapy Suffering Low-Altitude Falls","volume":"83","author":"Bauman","year":"2017","journal-title":"Am. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.wneu.2018.02.010","article-title":"Necessity of Repeat Computed Tomography Imaging in Isolated Mild Traumatic Subarachnoid Hemorrhage","volume":"113","author":"Kumar","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"289","DOI":"10.2214\/ajr.176.2.1760289","article-title":"Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT","volume":"176","author":"Brenner","year":"2001","journal-title":"Am. J. Roentgenol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"13761","DOI":"10.1073\/pnas.2235592100","article-title":"Cancer Risks Attributable to Low Doses of Ionizing Radiation: Assessing What We Really Know","volume":"100","author":"Brenner","year":"2003","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11940-013-0275-0","article-title":"Treatment of Acute Subdural Hematoma","volume":"16","author":"Gerard","year":"2014","journal-title":"Curr. Treat. Options Neurol."},{"key":"ref_43","first-page":"107","article-title":"Follow-up of Conservatively Managed Epidural Hematomas: Implications for Timing of Repeat CT","volume":"20","author":"Sullivan","year":"1999","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s12028-020-01037-8","article-title":"Time Course of Hemostatic Disruptions After Traumatic Brain Injury: A Systematic Review of the Literature","volume":"34","author":"Thelin","year":"2021","journal-title":"Neurocrit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1097\/01.TA.0000066183.02177.AF","article-title":"Preinjury Warfarin Use Among Elderly Patients With Closed Head Injuries in a Trauma Center","volume":"56","author":"Lavoie","year":"2004","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1080\/09540260310001606692","article-title":"Post Concussion Syndrome","volume":"15","author":"Ryan","year":"2003","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1542\/peds.2014-0158","article-title":"Duration and Course of Post-Concussive Symptoms","volume":"133","author":"Eisenberg","year":"2014","journal-title":"Pediatrics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1176\/appi.ajp.2017.17020235","article-title":"Prolonged Postconcussive Symptoms","volume":"175","author":"Quinn","year":"2018","journal-title":"Am. J. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Silver, J.M., McAllister, T.W., and Arciniegas, D.B. (2019). Textbook of Traumatic Brain Injury, American Psychiatric Publishing, Inc.. [3rd ed.].","DOI":"10.1176\/appi.books.9781615372645"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kobeissy, F.H. (2015). Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Frontiers in Neuroengineering, CRC Press.","DOI":"10.1201\/b18126"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"673","DOI":"10.2214\/ajr.150.3.673","article-title":"Prospective Comparative Study of Intermediate-Field MR and CT in the Evaluation of Closed Head Trauma","volume":"150","author":"Gentry","year":"1988","journal-title":"Am. J. Roentgenol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/01.ta.0000197385.18452.89","article-title":"Utility of Repeat Head Computed Tomography After Blunt Head Trauma: A Systematic Review","volume":"61","author":"Wang","year":"2006","journal-title":"J. Trauma Inj. Infect. Crit. Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:09:06Z","timestamp":1760144946000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":52,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192114311"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192114311","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,2]]}}}