Bedside CT Scanning Improves Quality of Neurointensive Patient Care

Diagnostic testing with computed tomography (CT) for scanning of the head, is a major component for the clinical decision-making process for patients treated in neurointensive care. A new study weighs the benefits of using bedside CT scanning to deter cases of secondary brain injury, which often occurs during intrahospital transports of critically ill patients (i.e. transport from neurointensive care to the radiology department). The study, "Bedside CT Scanning of the Head and Neuroprotection: Improved Quality of Neurointensive Care," is being presented during the 71st Annual Meeting of the American Association of Neurological Surgeons (AANS) in San Diego.

The five-year study, highlighting the use of bedside CT scanning for treatment of neurointensive care patients, will be presented by Thorsteinn Gunnarsson, MD, MSc, Annette Theodorsson, MD, and Jan Hillman, MD, PhD, on Wednesday, April 30, from 4:30 to 4:45 p.m.

Information received from diagnostic testing is invaluable for assessment of prognosis or therapy. In most hospitals, obtaining this information requires that patients be transported from the neurosurgery intensive care unit to the radiology department.

"Oftentimes when this transport occurs, patients run the risk of experiencing both technical and medical complications that could lead to secondary brain injury," said Thorsteinn Gunnarsson, MD, a co-author of the study and AANS member. "The study was designed to estimate the impact of bedside cranial CT scanning on secondary brain injury in a neurointensive care unit over a five-year period."

As part of the study, the authors reviewed their own previously published data reflecting medical and technical complications linked to intrahospital transports. In addition, they estimated the number of complications that could be avoided during the first five years of bedside CT scanning used in their neuro-ICU, as well as the extra number of minutes that patients gained in the controlled environment of the neuro-ICU and the impact on nursing staff hours in the neuro-ICU.

To avoid complications from intrahospital transports, a mobile CT scanner has been in use in the authors' neuro-ICU for more than five years (since 1997), and over 1,500 bedside CT scans of the head have been performed on critically ill neurosurgical patients during this time period.

During the five-year study, at least 1,200 intrahospital transports and 268 possible associated complications have been avoided. Even patient transports without any obvious technicalcomplication can lead to undesirable events because many patients are sensitive to almost any type of manipulation. Such events include rise in intracranial pressure, seizures, cardiac arrhythmias (alteration in heartbeat rhythm), hypo-or hypertension, decrease in oxygen saturation, and increased risk of infection. An additional benefit to bedside CT scanning was the number of additional minutes that patients could spend in the controlled environment of the neuro-ICU, which totaled 79,248.

"This figure should be compared to the fact that irreversible brain injury can occur only a after a few minutes of alteration in physiology, like a fall in blood pressure, caused by a transportation-related complication," said Dr. Gunnarsson. "With the bedside CT scanning technique, we have been able to eliminate transport-related risks and approximately one complication per week has been avoided."

In addition, the study analyzed the results of the impact on nursing staff hours in the neuro-ICU. In the authors' previous study, one transport on a medium risk patient for a single CT scan required 110 minutes of combined nursing time on the average, and the comparable figure for high-risk patients was 198 minutes. The nursing staff spent 180,544 more minutes in the neuro-ICU, which is equivalent to the time spent by one nurse on patient care during two years.

"A minor portion of a nurse's time is now spent on preparing and performing the bedside CT study, allowing he or she to remain in the neuro-ICU," said Dr. Gunnarsson. "The nurse can therefore assist other patients during the scanning procedure, enabling uninterrupted, quality patient care."

Another benefit is that the daily program of planned CT studies in the radiology department can go undisturbed. In addition, the mobile CT scanner can be used to examine also other body parts such as the chest, which can be of vital interest in the intensive care setting.

One disadvantage of the mobile CT scanner is that it presents a little higher exposure to radiation, compared with the latest conventional scanners. However, the authors have not had any serious complications associated with the use of the mobile CT scanning technique.

To date, the author's institution has a captive population of 1,000,000 people. With this caseload, one transport-related complication per week has been avoided by using bedside CT scanning.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.