Adapting the Canadian CT head rule age criteria for mild traumatic brain injury

Fournier, Nicolas; Gariepy, Charles; Prevost, J; Belhumeur, Vincent; Fortier, Emile; Carmichael, Pierre‐Hugues; Gariépy, Jean-Luc; Sage, Natalie Le; Émond, Marcel

doi:10.1136/emermed-2018-208153

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…Unlike the previous study conducted in Canada, a modified version of the CCHR with a cut-off age of 75 years retained 100% sensitivity but increased specificity to 13.9%. [9] This can be explained by the fact that in older patients, physicians often cannot obtain an accurate history of the accident, and the mechanism of head injury in the elderly is typically low, with a rare loss of consciousness. Additionally, all previous studies were conducted in Western populations, while our study focused on Asians.…”

Section: Discussionmentioning

confidence: 99%

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Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

Aramvanitch¹

2023

World J Emerg Med

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Section: Discussionmentioning

confidence: 99%

“…[8] A small study in Canada found that using a cut-off age of 75 years in the CCHR criteria increases specificity while maintaining 100% sensitivity. [9] Therefore, the current cut-off age of 65 years may not be appropriate for this population in terms of screening for TBI.…”

mentioning

confidence: 97%

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

Aramvanitch¹

2023

World J Emerg Med

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“…Many clinicians continue to interpret the rule as suggesting that all patients aged > 65 require a CTB after a head strike without considering whether it was appropriate to apply the rule in the first place. In a retrospective cohort study, Fournier at al [17]. demonstrated that increasing the high-risk age criteria from 65 years to 75 years was associated with an increase in the Fig.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Canadian CT head rule supplemented by the original published minimum inclusion criteria to assist emergency department clinicians’ assessment of patients presenting post fall from residential aged care: a retrospective audit

et al. 2022

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Background A large number of CT brain (CTB) scans are ordered in the ED for older patients with a confirmed or possible head strike but no ongoing symptoms of a head injury. This study aimed to evaluate the effect of the Canadian CT head rule supplemented by the original published minimum inclusion criteria to assist clinician assessment of the need for CTB following minimal trauma fall in patients presenting from residential aged care facilities to a major metropolitan emergency department (ED). Methods This study was conducted as a pre- and post-intervention retrospective audit. The intervention involved implementation of a decision support tool to help clinicians assess patients presenting to the ED following a fall. The tool integrated the Canadian CT Head Rule (CCHR) in conjunction with a simplified set of inclusion criteria to help clinicians define a minimum threshold for a “minor head injury”. Outcome data pertaining to CT brain ordering practices and results were compared over symmetrical 3-month time periods pre- and post-intervention in 2 consecutive years. Results The study included 233 patients in the pre-intervention arm and 241 in the post-intervention arm. Baseline demographics and clinical characteristics were similar in both groups. There was a 20% reduction in the total number of CTB scans ordered following tool implementation, with 134 (57.0%) scans in the pre-intervention group and 90 (37.3%) in the post-intervention group (p < 0.01). The diagnostic yield in the pre- and post-intervention groups was 3.7 and 5.6% respectively (p = 0.52). No variation was observed in medical management between groups, and no patients in either group underwent neurosurgical intervention. Conclusions Use of the CCHR supplemented by the original published minimum inclusion criteria appeared to safely reduce the number of CTB scans performed in residential aged care facility residents presenting to an ED after a fall, with no associated adverse outcomes. A larger study across multiple centres is required to determine widespread efficacy and safety of this tool.

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“…Due to this Fournier et al suggest increasing the age limit from 65 to 75 years-old. The fact of adjusting the age limit to 75 yearold in the Canadian head CT rule may reduce head CTscans performed of 25% without any intracranial lesion missed [27]. In their retrospective cohort, Riccardi et al even suggested to increase this limit to 80 years old [9].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous impact location: a new tool to predict intracranial lesion among the elderly with mild traumatic brain injury?

Dubucs

Balen

Schmidt

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Mild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over. Recent studies conducted in ED suggested a low intracranial lesion prevalence. The objectives of this study were to assess the prevalence and risk factors of intracranial lesion in older patients admitted to emergency department for mild traumatic brain injury by reporting in the emergency department the precise anamnesis of injury and clinical findings. Methods: Patients of 65 years old and over admitted in emergency department were prospectively included in this monocentric study. The primary outcome was the prevalence of intracranial lesion threw neuroimaging. Results: Between January and June 2019, 365 patients were included and 66.8% were women. Mean age was 86.5 years old (SD = 8.5). Ground-level fall was the most common cause of mild traumatic brain injury and occurred in 335 patients (91.8%). Overall, 26 out of 365 (7.2%) patients had an intracranial lesion. Compared with cutaneous frontal impact (medium risk group), the relative risk of intracranial lesion was 2.54 (95% CI 1.20 to 5.42) for patients with temporoparietal or occipital impact (high risk group) and 0.12 (95% CI 0.01 to 0.93) for patients with facial impact or no cutaneous impact (low risk group). There was not statistical increase in risk of intracranial injury with patients receiving antiplatelets (RR = 1.43; 95% CI 0.68 to 2.99) or anticoagulants (RR = 0.98; 95% CI 0.45 to 2.14). Conclusion: Among patients of 65 years old and over, the prevalence of intracranial lesion after a mild traumatic brain injury was similar to the younger adult population. The cutaneous impact location on clinical examination at the emergency department may identify older patients with low, medium and high risk for intracranial lesion.

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Adapting the Canadian CT head rule age criteria for mild traumatic brain injury

Cited by 12 publications

References 7 publications

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

Impact of the Canadian CT head rule supplemented by the original published minimum inclusion criteria to assist emergency department clinicians’ assessment of patients presenting post fall from residential aged care: a retrospective audit

Cutaneous impact location: a new tool to predict intracranial lesion among the elderly with mild traumatic brain injury?

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