Clinical Utility and Cost Analysis of Routine Follow-Up Head Computed Tomography at 24 Hours in Spontaneous Intracerebral Hemorrhage Patients.

Abstract

This study evaluates the functional outcomes and cost implications of routine repeat computed tomography (CT) scans at 24 hours for patients with spontaneous intracerebral hemorrhage (ICH), addressing a research gap focused mainly on traumatic brain injury and ischemic stroke. We performed a retrospective review of data from 212 initial conservative ICH patients, covering the period from October 2014 to August 2022. Patients were divided into 2 groups: those receiving routine CT scans approximately 24 hours after the initial scan and those receiving follow-up clinical scans based on clinical indications. The primary outcome measure was functional status at 1 month, assessed using the modified Rankin scale, where scores of 0-3 were deemed favorable. Hematoma expansion (HE) was defined as a volume increase of ≥33% or 6 ml. Cost data, including hospitalization and imaging expenses, were reported in US dollars. Among 212 patients, 105 (49.5%) underwent routine CT scans, while 107 (50.5%) had scans based on clinical indications, both starting with 11 ml ICH volume. Routine scans found HE in 19.1% of cases, a 10.6% increase, while CT with clinical indications detected 8.4%, incurring an additional cost of $101 per scan. Mean hospital costs per patient were higher in the routine CT group ($1055 ± 607.6) compared to the other group ($887.8 ± 1220.9), with a nonsignificant difference in favorable modified Rankin scale outcomes (56.2% vs. 49%). A 24-hour routine repeat CT scans detects 10.6% more HEs at an additional cost, but the associated benefits in outcomes are not statistically significant.