Prescription of Brain CT in Traumatic Brain Injury: A Prospective Audit in a Senegalese Level-2 Hospital (2024 – 2025)

Abstract

Background: Head injuries represent a major public health concern and are a leading cause of morbidity and mortality among young adults. Computed tomography (CT), an imaging modality based on ionizing radiation, is the gold standard for evaluating traumatic brain injury (TBI). The objective of this study was to quantify the yield of abnormal brain CT findings and to test whether initial loss of consciousness (ILOC) predicts abnormal imaging results. Methodology: We conducted a prospective, descriptive, and analytical study from January 2, 2024, to July 31, 2025, at the Radiology Department of Abdoul Aziz Sy Hospital in Tivaouane, Senegal. All patients who underwent brain CT scans for recent TBI were included. Results: A total of 521 CT scans were analyzed. Seventy-one percent of patients were male, and 65% were older than 15 years, with a mean age of 25 ± 18 years. The mechanism of injury was reported in 45 cases (8.6%), dominated by road traffic accidents (34 cases). Clinical data concerning the Glasgow Coma Scale (GCS) and other neurological signs were available for only 10 (1.9%) and 107 (20.5%) patients, respectively. Initial loss of consciousness was absent in 60.6% of cases. Brain CT findings were normal in 345 (66.2 %) of patients. Conclusion: Nearly three-quarters of brain CT scans performed for TBI were normal, highlighting gaps in documentation of clinical criteria that determine imaging appropriateness. Strengthening clinical documentation and applying validated decision rules could improve CT utilization and reduce unnecessary radiation exposure.These findings highlight the need for evidence-based imaging stewardship in West African regional hospitals.