- limitations of CT head imaging in TBI
- remote location, unfamiliar environment for dealing with emergencies
- requires an immobile patient (sedation/GA)
- difficult to monitor and attend to patient during scan
- requires specific equipment and staff
- may be limited by patient size (not usually head CT)
- may lead to delays
- may be other priorities (ie. laparotomy)
- interpretation may be difficult if artifacts (e.g. meta work) or previous contrast administration
- requires expertise
- not a continuous monitor
- shows only structure (no assessment of function)
- a normal CT doesn’t exclude underlying injury (ie. DAI, vascular injury, ischaemia, hypoxia) –> may need to repeat 24 hrs
- CT findings do not always correlate with ICP values
- CT findings not always good predictors of outcome
- brainstem and posterior fossa poorly visualised
- radiation exposure
- contrast needed for vascular injury (risk of allergy and contrast-induced nephropathy)
References and Links
- CCC – Traumatic Brain Injury: Assessment
- CCC – Traumatic Brain Injury: Management
- CCC – Traumatic Brain Injury: Monitoring
- CCC – Traumatic Brain Injury: Prognosis
- CCC – Traumatic brain injury: Overview
- CCC – Increased ICP in TBI
- CCC – Cerebral Perfusion Pressure (CPP) in TBI
- CCC – Traumatic brain injury: Literature Summaries
- Brain Trauma Foundation Guidelines – Guidelines for the Management of Severe TBI
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.