Does Routine Repeat CT at 24 and 48 Hours Alter Management in Clinically-Stable Mild and Moderate Head Injury? A Prospective Observational Study

Abstract Computed tomography (CT) is central to the evaluation of traumatic brain injury (TBI). While repeat CT imaging is routinely recommended in severe head injury, its role in clinically-stable mild and moderate TBI remains controversial, particularly in the absence of neurological deterioration. The present prospective observational study included 177 adult and pediatric patients with mild (Glasgow Coma Scale [GCS] 13–15) and moderate (GCS 9–12) head injury who remained clinically stable. Brain CT was performed at admission, followed by routine repeat CT at 24 hours and selective repeat CT at 48 hours. Radiological progression, impact on medical or surgical management, and outcomes were analyzed. Radiological lesion progression without neurological deterioration was observed in 30 patients (16.9%). Repeat CT at 24 hours detected lesion enlargement in 25 patients (14.1%), while repeat CT at 48 hours detected progression in an additional 5 patients. Overall, repeat CT resulted in a change in management in 18 patients (10.2%), including surgical intervention in 13 patients (7.3%) and escalation of medical therapy in 5 patients (2.8%). Most management changes were prompted by the 24-hour repeat CT. Favorable outcomes (Glasgow Outcome Scale 4–5) were observed in 87% of patients. Routine repeat CT imaging at 24 hours, with selective imaging at 48 hours, can detect clinically silent but significant lesion progression and influence management in a meaningful proportion of clinically-stable mild and moderate head injury patients.