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Master Thesis

Intérêt thérapeutique de la tomodensitométrie cérébrale de contrôle après traumatisme crânien grave

Abstract : INTRODUCTION: Performing a repeat brain computed tomography (CT) scan is a widespread practice during initial management of severe traumatic brain injured patients (TBI), but its interest in treatment decision-making is unclear.
OBJECTIVE: To evaluate the therapeutic value of repeat brain CT scan in a population of severe TBI patients with invasive monitoring of intracranial pressure (ICP).
PATIENTS AND METHODS: We conducted a 4-year retrospective observational study including all severe TBI patients (Glasgow coma score ≤ 8) with invasive ICP monitoring and who underwent repeat brain CT scan during the First 48 hours. We dichotomized the patients according to whether they had the repeat CT scan routinely or motivated by a neurological degradation and compared these two populations. The primary endpoint was the modification of neurological management (osmotherapy or neurosurgery) after performing the repeat brain CT scan.
RESULTS: We included 127 patients, 25 (20%) received a motivated brain CT scan and 102 (80%) a routine brain CT scan. Both groups were comparable in terms of Glasgow coma scores and IGS2, and on the use of drugs interfering with coagulation. Patients in the motivated brain CT scan group presented more intracranial hypertension at baseline (56% vs. 28%, p = 0.01), needed more osmotherapy (68% vs. 41%, p = 0.02), and had higher Marshall scores on both CT scan. None of the patients in the routine CT scan group underwent a therapeutic intervention following this scan, compared to 4 patients (16%) in the motivated CT group (p <0.01).
CONCLUSION: After severe head injury, the systematic brain CT scan does not involve any therapeutic modification as opposed to a brain CT scan motivated by a neurological degradation.
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Master Thesis
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Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Tuesday, November 3, 2020 - 2:19:21 PM
Last modification on : Saturday, February 20, 2021 - 3:11:19 AM


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  • HAL Id : dumas-02986985, version 1


Ludovic Rousseau. Intérêt thérapeutique de la tomodensitométrie cérébrale de contrôle après traumatisme crânien grave. Médecine humaine et pathologie. 2019. ⟨dumas-02986985⟩



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