MEDICAL DECISION-MAKING FOR REPEATED COMPUTED-TOMOGRAPHY IN NEUROSURGICAL INTENSIVE-CARE PATIENTS

Multiple CT investigations in critical ill neurosurgical patients are useful for monitoring the course of the illness and for the early dete ction of complications. CT's, however, are expensive and require trans portation of the patient, which is often inconvenient and, in some cas es, dangerous. The decision to perform CT scanning should be based on the quantitative knowledge of potential benefits and harms (as well as costs) of the procedure. In a prospective trial, in which 59 such dec isions were considered, we found it to be absolutely necessary to orde r a CT-investigation whenever neurological deterioration occurs. Even in patients not showing changes of neurological symptoms, about 30% of CT findings gave reason for therapeutic intervention. Thus, in critic al ill neurosurgical patients, especially in those under sedative medi cation and artificial ventilation, neurological findings alone are ins ufficient as sole criteria for the decision to order a CT scan. To opt imize this decision, more sensitive indicators of deterioration are ne eded.