Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan

Mata‐Mbemba, Daddy; Mugikura, Shunji; Nakagawa, Atsuhiro; Murata, Takaki; Kato, Yumiko; Tatewaki, Yasuko; Takase, Kei; Kushimoto, Shigeki; Tominaga, Teiji; Takahashi, Satoshi

doi:10.1186/s40064-016-1781-9

Cited by 23 publications

(24 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When correctly applied, both the CCHR and NOC lead to slightly more than 50% of patients being scanned with computerized tomography (CT) of the head [21]. The CCHR guidelines are constructed chiefly to rule out intracranial hemorrhage requiring intervention and have been validated with a 100% detection rate [21][22][23]. The SNC guidelines aim to detect all intracranial hemorrhages and have been prospectively validated as safe [18].…”

Section: Introductionmentioning

confidence: 99%

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Vedin

Karlsson

Edelhamre

et al. 2019

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention. Methods A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived "low-risk proposal" and applied retrospectively to the cohort. Results Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention. Conclusion For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.

show abstract

Section: Introductionmentioning

confidence: 99%

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Vedin

Karlsson

Edelhamre

et al. 2019

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…11 This study focused on CCHR, 4 which can be used for minor head trauma in patients with GCS scores between 13 and 15, and evaluated its diagnostic power to determine patients with minor head trauma who should be evaluated with head CT. Mata-Mbemba et al compared CCHR and NOC in 142 patients to identify important CT findings among patients with GCS scores from 13 to 15 and found that CCHR had lower sensitivity, higher specificity, and higher accuracy than NOC (sensitivity, 89.8% vs. 97.9%; specificity, 24.7% vs. 9.7%; and accuracy, 47.2% vs. 40.1%). 12 In this study, the overall performance of CCHR was superior to that of NOC in patients with minor head trauma. A study by Kavalci et al comparing CCHR and NOC reported that the sensitivity, specificity, PPV and NPV of CCHR were 100%, 0%, 42%, and 100%, respectively, in patients with a GCS score of 13.…”

Section: Discussionmentioning

confidence: 58%

Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

Kızılgöz

Avcı

Sivrioğlu

et al. 2019

MNJ

View full text Add to dashboard Cite

Background: Head computed tomography (CT) scans, which provide reliable information to assessor rule out neurological abnormalities and injuries, should be used judiciously to minimize radiation exposure and cost. Objective: The aim of this study was to evaluate the widely used Canadian CT Head Rule (CCHR) to determine the necessity of head CT scans in patients with minor head trauma. Methods: This retrospective study included 913 patients with head trauma who were admitted to Harakani State Hospital between June 2014 and December 2017. The patient data were reevaluated according to CCHR and compared with the radiological findings. Results: There were a total of 556 patients fulfilling the inclusion criteria with a male/female ratio of 2.95 and a mean age of 37 ± 4.24 years. The most common injury mechanism of head trauma was motor vehicle accidents. Chi square tests were applied for statistical calculations. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CCHR were 93%, 88%, 88%, 94%, and 90%, respectively. Conclusion: CCHR was highly useful for patients with minor head trauma who could benefit from head CT evaluation with high sensitivity and specificity.

show abstract

“…[ 16 ] There is a lot of controversy in the use of CT in head trauma, especially in MHI. Different guidelines are followed in different parts of the world for taking CT.[ 6 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 5 ] There is a lot of controversy in the use of CT, especially in MHI. [ 6 7 ] This study was intended to estimate the rate of CT positivity and to define the criteria for doing head CT in our patient population with special emphasis on MHI.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

Waganekar

Jagadish

Prabhu

et al. 2018

J Emerg Trauma Shock

View full text Add to dashboard Cite

Context:Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13–15), moderate (GCS 9–12), and severe (GCS 3–8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients.Aims:This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients.Settings and Design:This was a prospective observational study in the emergency department (ED) over a 12-month period. Subjects andMethods:Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC), vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication.Statistical Analysis Used:Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square.Results:A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI), CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed.Conclusions:From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12). Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

show abstract

Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan

Cited by 23 publications

References 19 publications

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Evaluation of the Canadian Ct Head Rule for Analyzing Diagnostic Accuracy in Patients 4 With Minor Head Trauma

Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

Contact Info

Product

Resources

About