The Canadian CT Head Rule for patients with minor head injury

Stiell, Ian G.; Wells, George A.; Vandemheen, Katherine L.; Clement, Catherine M.; Lesiuk, Howard; Laupacis, Andreas; McKnight, R. Douglas; Verbeek, Richard; Brison, Robert J.; Cass, Daniel T.; Eisenhauer, Mary A.; Greenberg, Gary H.; Worthington, James

doi:10.1016/s0140-6736(00)04561-x

Cited by 1,262 publications

(1,001 citation statements)

References 27 publications

Supporting

Mentioning

921

Contrasting

Unclassified

Order By: Relevance

“…These methods have been used in other high calibre decision rule studies. [32][33][34][35] Our study also has potential limitations. The outcome "urological intervention" can vary among urologists in different geographic areas and may be influenced by independent patient factors such as associated ureteral pathology, patient occupation and patient preference.…”

Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

View full text Add to dashboard Cite

Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

show abstract

Section: Discussionmentioning

confidence: 92%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

View full text Add to dashboard Cite

show abstract

“…It was derived in 2001 in a multicenter prospective cohort study involving 3,121 patients who presented to the ED following blunt trauma to the head with a GCS score of 13-15. 4 In 2005, it underwent prospective validation among 1,822 patients and demonstrated 100% sensitivity and a specificity of 50.6% and 76.3% for predicting clinically important brain injury and need for neurosurgical intervention, respectively. 5 The derivation and validation of the CCR and CCHR were published in prominent general medical journals.…”

mentioning

confidence: 99%

“…5 The derivation and validation of the CCR and CCHR were published in prominent general medical journals. [2][3][4][5] Nevertheless, it is far from clear that publication within the medical literature influences clinician knowledge or is subsequently translated into use. 6,7 Little is known about factors that determine widespread adoption of clinical decision rules into mainstream practice.…”

mentioning

confidence: 99%

International Survey of Emergency Physicians’ Awareness and Use of the Canadian Cervical‐Spine Rule and the Canadian Computed Tomography Head Rule

Eagles

Stiell

Clement

et al. 2008

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The derivation and validation studies for the Canadian Cervical-Spine (C-Spine) Rule (CCR) and the Canadian Computed Tomography (CT) Head Rule (CCHR) have been published in major medical journals. The objectives were to determine: 1) physician awareness and use of these rules in Australasia, Canada, the United Kingdom, and the United States and 2) physician characteristics associated with awareness and use.Methods: A self-administered e-mail and postal survey was sent to members of four national emergency physician (EP) associations using a modified Dillman technique. Results were analyzed using repeatedmeasures logistic regression models.Results: The response rate was 54.8% (1,150 ⁄ 2,100). Reported awareness of the CCR ranged from 97% (Canada) to 65% (United States); for the CCHR it ranged from 86% (Canada) to 31% (United States). Reported use of the CCR ranged from 73% (Canada) to 30% (United States); for the CCHR, it was 57% (Canada) to 12% (United States). Predictors of awareness were country, type of rule, full-time employment, younger age, and teaching hospital (p < 0.05). Significant differences in use of the CCR by country were observed, but not for the CCHR. Teaching hospitals were more likely to use the CCR than nonteaching hospitals, but less likely to use the CCHR.Conclusions: This large international study found notable differences among countries with regard to knowledge and use of the CCR and CCHR. Awareness and use of both rules were highest in Canada and lowest in the United States. While younger physicians, those employed full-time, and those working in teaching hospitals were more likely to be aware of a decision rule, age and employment status were not significant predictors of use. A better understanding of factors related to awareness and use of emergency medicine (EM) decision rules will enhance our understanding of knowledge translation and facilitate strategies to enhance dissemination and implementation of future rules.

show abstract

“…Telephone followup was conducted via structured phone interview, using the Canadian CT Head and Cervical Spine Radiography Study Telephone Followup survey tool. This assessment tool has been previously validated in a large clinical study of mild TBI subjects [18].…”

Section: Imaging and Clinicalmentioning

confidence: 99%

Serum Levels of Biochemical Markers of Traumatic Brain Injury

Borg

Bonomo

Jauch

et al. 2012

ISRN Emergency Medicine

View full text Add to dashboard Cite

Background. A biomarker would be valuable in the diagnosis, risk stratification and prognosis of patients with traumatic brain injury (TBI). Methods. We measured serum levels of S-100β, neuron specific enolase (NSE) and myelin basic protein (MBP) in 50 TBI subjects, and 50 age and gender matched controls. Patients were recruited within 6 hours of the initial injury, they had an initial Glasgow Coma Scale (GCS) score of 14 or less, or a GCS score of 15 with witnessed loss of consciousness (LOC) or amnesia. Results. S-100β, NSE and MBP levels were significantly higher in TBI subjects than in control subjects (P < 0.001 for S-100β and NSE; P = 0.009 for MBP). Initial S-100β levels were significantly higher in TBI subjects who had not retuned to normal activities 2 weeks following their injury than in TBI subjects who had retuned to normal activities (P = 0.022). MBP levels were higher in TBI subjects with positive findings on the baseline CT scan than in CT-negative subjects (P = 0.007). Conclusions. S-100β, NSE and MBP may be present in the sera of TBI subjects in elevated quantities relative to controls. S-100β may aid in predicting short-term outcome in TBI subjects.

show abstract

The Canadian CT Head Rule for patients with minor head injury

Cited by 1,262 publications

References 27 publications

Predicting intervention in renal colic patients after emergency department evaluation

Predicting intervention in renal colic patients after emergency department evaluation

International Survey of Emergency Physicians’ Awareness and Use of the Canadian Cervical‐Spine Rule and the Canadian Computed Tomography Head Rule

Serum Levels of Biochemical Markers of Traumatic Brain Injury

Contact Info

Product

Resources

About