Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

Abstract

Object This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR). Methods This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma. Results Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%. Conclusions The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

“…122 For this reason, researchers in Ohio have been working to develop and validate geriatric trauma-field triage criteria to optimally identify older adults with TBI who require emergent transfer to a trauma center, for example, a GCS cutoff of £14 (vs. £13 for younger individuals). [123][124][125] Most, but not all, 126 existing rules and validation studies support the routine use of head CT for all patients >60 102 or >65 years of age 103,104,127,128 presenting with mild TBI even after rapid return to baseline. The American College of Emergency Physicians recommends considering head CT in all patients ages ‡65 years who present with TBI, even mild injury without loss of consciousness (LOC), and recommends obtaining a head CT in all patients >60 years of age with TBI and LOC.…”

Management and outcome of traumatic subdural hematoma in 47 infants and children from a single center

“…There are still problems with hematoma removal in infants due to the technical difficulty of full evacuation and the potential danger of iatrogenic hemorrhage [13]. One aspect could help such decisions: while secondary risk factors influence the outcome significantly in adult brain-trauma patients [14], this effect is less apparent in children [15]. This is also supported by the data of the performed study.…”

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury

“…Age is a risk factor for ICH, even in mild HI. In the Canadian CT Head Rule [ 11 ] and New Orleans Criteria [ 10 ], the elderly have a greater risk of clinically significant lesions that require acute neurosurgical intervention or prolonged inpatient observation [ 23 , 24 ]. Early CT scanning, where it is available, is strongly indicated [ 23 , 24 ].…”