Accuracy of Canadian CT head rule in predicting positive findings on CT of the head of patients after mild head injury in a large trauma centre in Saudi Arabia

Arab, Ala; Ahmed, Muhammad Ejaz; Ahmed, Anwar; Hussein, Mohamed A.; Khankan, Azzam; Alokaili, Riyadh

doi:10.1177/1971400915610699

Cited by 18 publications

(15 citation statements)

References 12 publications

(14 reference statements)

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“…We demonstrated a sensitivity of 70% if the rule was applied. Similar studies have shown a 66.67% sensitivity (13) which is comparative to this study. The rule was shown to have a negative predictive value 87.5%.…”

Section: Discussionsupporting

confidence: 88%

“…In developed countries, the use of CT scans in traumatic brain injuries is very common but the yield for intracranial injuries is relatively low at 0.7-3.7% (7,13). This represents a cost of 135-216 million dollars annually (7).…”

Section: Discussionmentioning

confidence: 99%

“…This represents a cost of 135-216 million dollars annually (7). The Canadian Head CT (Appendix A) rule was developed with this in mind (13). It standardizes the emergency management of patients with mild traumatic brain injury with improved utilization of resources.This study showed that there is an overuse of CT scans for minor head injury patients.…”

Section: Discussionmentioning

confidence: 99%

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The Canadian head CT rule; a hospital audit

Kinyua¹

2018

Ann Afr Surg.

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Background: Minor head trauma is one of the leading cause of emergency department visits worldwide. The Canadian Head CT-scan rule (CCHR) in minor head injury is an evidence-based aid in decision making as regards to use of CT-scans to detect head injury requiring neuro-intervention. It therefore avoids wastage of resources. The objective was to compare the number of CT-scans done for minor head injury as compared to the number that would have been done if the CCHR was applied. Methods: A retrospective study was done. All patients resenting with minor head injury (GCS 13-15) were identified from the hospital registry and their files obtained. Patients not meeting the CCHR criteria excluded. Ten parameters were extracted and tabulated. Results: Forty-one patients were included with three exclusions. 89% (n=34) of the patients presented with a 2-hour GCS of 13 or more. 11% (n=4) were suspicious of base skull fractures. 23% (n=9) had signs of open fracture. Vomiting was seen in 2 patients (5%).

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Canadian head CT rule; a hospital audit

Kinyua¹

2018

Ann Afr Surg.

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“…Parte deles analisou somente a diretriz CCHR. Arab et al ( 2015) 9 aplicaram retrospectivamente a diretriz CCHR em 368 pacientes atendidos com TCE leve e que, na ocasião de seu atendimento, haviam realizado tomografia de crânio. Após essa análise, verificaram que a prevalência de tomografias não justificadas, segundo a diretriz, foi de 61,8%.…”

Section: Discussionunclassified

Impacto Da Aplicação De Diretrizes Na Solicitação De Tomografia Computadorizada De Crânio Em Traumatismo Cranioencefálico Leve: Revisão Sistemática

Gomes

Cade

Souza

et al. 2022

RMP

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RESUMO - A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.

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“…Multiple validated clinical decision rules have been established to standardize and increase the efficiency of CT indication in patients after mTBI [5][6][7][8][9][10]. The Canadian CT Head Rule (CCHR) is the most common and has been found to be highly sensitive for detecting intracranial lesions; however, its specificity varies widely [10][11][12][13]. Other rules, such as the New Orleans criteria, the NICE, the Scandinavian rules, and NEXUS-II, based on different clinical and demographic indicators for imaging, have also demonstrated their validity and generalizability [9,14].…”

Section: Introductionmentioning

confidence: 99%

Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

Sakkas

Weiß

Ebeling

et al. 2023

JCM

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The primary aim was to determine the clinical indicators for primary cranial CT imaging in patients after mild traumatic brain injury (mTBI). The secondary aim was to evaluate the need for post-traumatic short-term hospitalization based on primary clinical and CT findings. This was an observational retrospective single-centre study of all the patients who were admitted with mTBI over a five-year period. Demographic and anamnesis data, the clinical and radiological findings, and the outcome were analyzed. An initial cranial CT (CT0) was performed at admission. Repeat CT scans (CT1) were performed after positive CT0 findings and in cases with in-hospital secondary neurological deterioration. Intracranial hemorrhage (ICH) and the patient’s outcome were evaluated using descriptive statistical analysis. A multivariable analysis was performed to find associations between the clinical variables and the pathologic CT findings. A total of 1837 patients (mean age: 70.7 years) with mTBI were included. Acute ICH was detected in 102 patients (5.5%), with a total of 123 intracerebral lesions. In total, 707 (38.4%) patients were admitted for 48 h for in-hospital observation and six patients underwent an immediate neurosurgical intervention. The prevalence of delayed ICH was 0.05%. A Glasgow Coma Scale (GCS) of <15, loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of fracture were identified as clinical factors with significantly higher risk of acute ICH. None of the 110 CT1 presented clinical relevance. A GCS of <15, loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of cranial fractures should be considered absolute indicators for primary cranial CT imaging. The reported incidence of immediate and delayed traumatic ICH was very low and hospitalization should be decided individually considering both the clinical and CT findings.

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Accuracy of Canadian CT head rule in predicting positive findings on CT of the head of patients after mild head injury in a large trauma centre in Saudi Arabia

Abstract: The level of education regarding the CCHR was found to be optimal among emergency physicians using a case-based scenario survey. The CCHR was found to have a poor compliance potential in the busy ED of our trauma centre and the prevalence of unjustified cranial CT scans remained high.

Cited by 18 publications

References 12 publications

The Canadian head CT rule; a hospital audit

The Canadian head CT rule; a hospital audit

Impacto Da Aplicação De Diretrizes Na Solicitação De Tomografia Computadorizada De Crânio Em Traumatismo Cranioencefálico Leve: Revisão Sistemática

Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

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