Evaluating the Utility of Repeat CT Scans in Patients With Isolated Traumatic Subarachnoid Hemorrhage

INTRODUCTION: Subarachnoid hemorrhage (SAH) is a relatively common consequence of head trauma. Treatment of traumatic SAH (tSAH) patients often involves serial CT imaging to assess for expansile hemorrhage. However, evidence suggests that tSAH rarely leads to neurologic deterioration or necessitates neurosurgical intervention, particularly in patients who present neurologically intact. Thus, the current standard of care may be overly extensive. METHODS: Patients presenting to Mass General Brigham Hospitals with tSAH between 2000 and 2021 were eligible for inclusion. Patients were excluded if: (a) their SAH was non-traumatic, (b) they experienced another form of intracerebral hemorrhage, or (c) they had a documented GCS of 12 or lower. Univariate and multivariate regression models were used to analyze the retrospectively collected data. RESULTS: Overall, 293 patients were included, 130 of which were male. The most common mechanism of trauma was fall from standing (n = 171). 131 patients presented with other significant traumatic injuries in addition to their tSAH. The mean number of total CTs for all patients was 2.3, with 230 patients (78.50%) receiving at least two CT scans and 92 patients (31.40%) receiving three or more scans. Of the 230 patients receiving multiple scans, only 12 (5.22%) had any degree of documented hemorrhagic expansion. No patients developed acute neurologic deterioration or required neurosurgical intervention related to their bleed. CONCLUSIONS: The standard of care for tSAH patients centers on close observation and repeat CT imaging. However, these repeat CTs rarely demonstrate any degree of hemorrhagic expansion for patients who present neurologically intact. Excessive CT imaging is thus unlikely to affect patient management and potentially presents an unnecessary burden to both the patient and the hospital staff.