Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

Korley, Frederick K.; Kelen, Gabor D.; Jones, Courtney Marie Cora

doi:10.1097/htr.0000000000000187

Cited by 94 publications

(75 citation statements)

References 41 publications

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“…However, emergency department evaluations for patients with mild TBI have not been sufficiently described [12]. It has been demonstrated that both the standard clinical interview and CT scans have limited sensitivity for diagnosing mild TBI [13].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is likely that a significant fraction of patients evaluated in the emergency department for TBI but did not ultimately receive a diagnosis did in fact sustain TBI. In addition, Korley et al, [12] determined that of the approximately 3.9 million head CT scans obtained in emergency departments each year to evaluate TBI, 91% did not reveal a traumatic intracranial abnormality. The number of negative head CT scans represents high-volume, high-cost, but low-value testing-not to mention increasingly recognized radiation risk [16].…”

Section: Discussionmentioning

confidence: 99%

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The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study

Hamrah¹,

Mehrvarz²,

Mirghassemi³

2018

BEAT

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Objective: To determine the frequency of the brain CT-scan findings in patients with mild traumatic brain injury (TBI) and scalp lacerations. Methods: This cross-sectional study was conducted during a 1-year period from March 2016 to March 2017 in Level I trauma center in Shiraz, Southern Iran. We included all the adult patients (≥18 years) admitted to our emergency room with mild TBI (GCS on admission of 15) and scalp lacerations. All the patients underwent Brain CT-Scan and the scans were reviewed by two radiologists who were unaware of the patients' clinical findings. The results are reported as proportions and frequencies. Results: Overall we included a total number of 94 patients with minimal TBI who had a scalp laceration on admission. The mean age of the patients was 30.78±8.01 (ranging from 18 to 47) years. There were 58 (61.7%) men and 36 (38.3%) women among the patients. The most common finding of the Brain CT-Scan was subgaleal hematoma in 76 (80.9%) patients followed by base skull base fracture in 7 (7.4%), linear skull fracture in 7 (7.4%), brain contusion in 3 (3.2%) and subdural hematoma in 1 (1.1%). Conclusion:The results of the current study indicate that scalp lacerations are associated with intracranial injuries in about 20% of the patients with mild TBI. Thus brain CT-scan is recommended in all the patients with mild TBI and scalp lacerations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study

Hamrah¹,

Mehrvarz²,

Mirghassemi³

2018

BEAT

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“…Head computed tomographic (CT) imaging is performed in 3.9 million of these patients, of which 400,000 (10%) are positive for any traumatic abnormality [1]. …”

Section: Introductionmentioning

confidence: 99%

Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study

et al. 2017

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BackgroundClinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99.0%.A secondary goal of the study was to complete an independent validation and comparison of the Canadian and NEXUS Head CT rules among the subgroup of patients meeting the inclusion and exclusion criteria.Methods and findingsWe conducted a prospective observational study of the NEXUS Head CT DI in 4 hospital emergency departments between April 2006 and December 2015. Implementation of the rule requires that patients satisfy 8 criteria to achieve “low-risk” classification. Patients are excluded from “low-risk” classification and assigned “high-risk” status if they fail to meet 1 or more criteria. We examined the instrument’s performance in assigning “high-risk” status to patients requiring neurosurgical intervention among a cohort of 11,770 blunt head injury patients.The NEXUS Head CT DI assigned high-risk status to 420 of 420 patients requiring neurosurgical intervention (sensitivity, 100.0% [95% confidence interval [CI]: 99.1%–100.0%]). The instrument assigned low-risk status to 2,823 of 11,350 patients who did not require neurosurgical intervention (specificity, 24.9% [95% CI: 24.1%–25.7%]). None of the 2,823 low-risk patients required neurosurgical intervention (negative predictive value [NPV], 100.0% [95% CI: 99.9%–100.0%]).The DI assigned high-risk status to 759 of 767 patients with significant intracranial injuries (sensitivity, 99.0% [95% CI: 98.0%–99.6%]). The instrument assigned low-risk status to 2,815 of 11,003 patients who did not have significant injuries (specificity, 25.6% [95% CI: 24.8%–26.4%]). Significant injuries were absent in 2,815 of the 2,823 patients assigned low-risk status (NPV, 99.7% [95% CI: 99.4%–99.9%]).Of our patients, 7,759 (65.9%) met the inclusion and exclusion criteria of the Canadian Head CT rule, including 111 patients (1.43%) who required neurosurgical intervention and 306 (3.94%) who had significant intracranial injuries. In our study, the Canadian criteria for neurosurgical intervention identified 108 of 111 patients requiring neurosurgical intervention to yield a sensitivity of 97.3% (95% CI: 92.3%–99.4%) and exhibited a specificity of 58.8% (95% CI: 57.7%–59.9%). The NEXUS rule, when applied to this same cohort, identified all 111 patients requiring neurosurgical intervention, yielding a sensitivity of 100% (95% CI: 96.7%–100.0%) with a specificity of 32.6% (95% CI: 31.5%–33.6%). Our study found that the Canadian medium-risk factors identified 301 of 306 patients with significant injuries (sensitivity = 98.4%; 95% CI: 96.2...

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“…In the USA, TBI is evaluated in approximately 4.8 million emergency department visits per year, and 52% of evaluations have involvement with TBI [2]. The incidence of emergency department visits, hospital admissions, and deaths of TBI is 78.2%, 18.5%, and 3.3%, respectively[3].…”

Section: Introductionmentioning

confidence: 99%

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Shen

Wang

et al. 2016

PLoS ONE

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BackgroundThe Brain Trauma Foundation (BTF) guidelines published in 2007 suggest some indications for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). However, some studies had not shown clinical benefit in patients with severe TBI; several studies had even reported that ICP monitoring was associated with an increased mortality rate. The effect of ICP monitoring has remained controversial, regardless of the ICP monitoring guidelines. Here we performed a meta-analysis of published studies to assess the effects of ICP monitoring in patients with severe TBI.MethodsWe searched three comprehensive databases, the Cochrane Library, PUBMED, and EMBASE, for studies without limitations published up to September 2015. Mortality, ICU LOS, and hospital LOS were analyzed with Review Manager software according to data from the included studies.ResultsEighteen eligible studies involving 25229 patients with severe TBI were included in our meta-analysis. The results indicated no significant reduction in the ICP monitored group in mortality (hospitalized before 2007), hospital mortality (hospitalized before 2007), mortality in randomized controlled trials. However, overall mortality, mortality (hospitalized after 2007), hospital mortality (hospitalized after 2007), mortality in observational studies (hospitalized after 2007), 2-week mortality, 6-month mortality, were reduced in ICP monitored group. Patients with an increased ICP were more likely to require ICP monitoring.ConclusionSuperior survival was observed in severe TBI patients with ICP monitoring since the third edition of “Guidelines for the Management of Severe Traumatic Brain Injury,” which included “Indications for intracranial pressure monitoring,” was published in 2007.

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Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

Cited by 94 publications

References 41 publications

The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study

The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study

Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

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