The role of imaging in head trauma.

Abstract

Head trauma is the most common injury around the world and millions of people from different age groups sustain a head injury. The most common injuries are from motor vehicle accidents where the person suffering head trauma is either riding as a passenger in the car or struck as a pedestrian. Other causes of head trauma are falls and violence. Head injury is classified into three groups ranging from severe, moderate and mild head trauma. Severe and moderate head trauma are quite serious injuries because the brain is always involved. On the other hand, in mild head trauma the patient suffering head injury can have either a localized injury or an intracranial injury or both. For high diagnostic efficiency, the initial management in head trauma is very important. Choosing the appropriate imaging modality according to the severity and the state of the patient is very important so that the benefits for the patient outweigh the risks. This is not always simple and most of the times it can be very challenging especially when the patient enters the accident and emergency department suffering from minor head trauma. The medical team should be competent enough to decide which imaging modality would best suit a particular patient based on the initial clinical assessment. The different imaging modalities currently available include plain x-ray of the skull, a CT scan, an MRI or other imaging modalities like PET or Ultrasound. Each modality has got its advantages and disadvantages and applicability varies in different patients and in different situations. Choosing the appropriate imaging modality depends on many factors such as sensitivity and specificity and of course availability and accessibility of the modality. Research and evidence based studies have contributed highly to the management of head trauma patients. Several guidelines were implemented over the years in order to assist the medical team in choosing the best imaging modality and in many countries these guidelines are becoming standard protocols aiming at objectively assisting the medical team with choosing the best imaging modalities for head trauma patients. A brief analysis of the different types of guidelines was attempted in this study. With regards to the local situation in Malta, an analysis of the management of head trauma patients at St Luke's Hospital was also carried out. Currently no guidelines are formally used to assess and manage head injured patients in our main tertiary hospital and the choice of the different imaging modalities depends entirely on subjective clinical judgement. All these factors have encouraged me as the researcher to conduct a literature-based study on the role of different imaging modalities in head trauma so as to evaluate the importance of each imaging modality in the different stages of head trauma.