Abstract
BackgroundTraumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide. Most traumatic brain injuries are classified as mild, with a low but not negligible risk of intracranial hemorrhage. To help physicians decide which patients might benefit from a computerized tomography (CT) of the head to rule out intracranial hemorrhage, several clinical decision rules have been developed and proven effective in reducing the amount of negative CTs, but they have not been compared against one another in the same cohort as to which one demonstrates the best performance.MethodsThis study involved a retrospective review of the medical records of patients seeking care between January 1 and December 31, 2017 at Helsingborg Hospital, Sweden after head trauma. The Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), the National Emergency X-Radiography Utilization Study II (NEXUS II), the National Institute of Health and Care Excellence (NICE) guideline and the Scandinavian Neurotrauma Committee (SNC) guideline were analyzed. A theoretical model for each guideline was constructed and applied to the cohort to yield a theoretical CT-rate for each guideline. Performance parameters were calculated and compared.ResultsOne thousand three hundred fifty-three patients were included; 825 (61%) CTs were performed, and 70 (5.2%) cases of intracranial hemorrhage were found. The CCHR and the NOC were applicable to a minority of the patients, while the NEXUS II, the NICE, and the SNC guidelines were applicable to the entire cohort. A theoretical application of the NICE and the SNC guidelines would have reduced the number of CT scans by 17 and 9% (P = < 0.0001), respectively, without missing patients with intracranial hemorrhages requiring neurosurgical intervention.ConclusionA broad application of either NICE or the SNC guidelines could potentially reduce the number of CT scans in patients suffering from mTBI in a Scandinavian setting, while the other guidelines seemed to increase the CT frequency. The sensitivity for intracranial hemorrhage was lower than in previous studies for all guidelines, but no fatality or need for neurosurgical intervention was missed by any guideline when they were applicable.
Highlights
Traumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide
Seventy (5.2%) cases showed at least one type of intracranial hemorrhage
The 89 excluded cases because of previous evaluations consisted of 23 patients who were previously evaluated in another hospital outside our catchment area and 66 patients who were previously evaluated in Helsingborg Hospital
Summary
Traumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide. Most traumatic brain injuries are classified as mild, with a low but not negligible risk of intracranial hemorrhage. Traumatic brain injury (TBI) is a common occurrence in emergency departments (EDs), resulting in an estimated 2.1 million hospital admissions (287.2/100,000) and 82, 000 deaths (11.7/100,000) in Europe in 2012 [1]. TBI can be categorized as minimal, mild, moderate, or severe, depending on the patient’s level of consciousness according to the Glasgow Coma Scale (GCS) and the presence or the absence of certain characteristics. Minimal TBI is defined as GCS 15 without loss of consciousness (LOC) or amnesia. Mild TBI (mTBI) is defined as GCS 14–15, associated with amnesia, brief LOC, or impaired alertness or memory. Moderate TBI is defined as GCS 9–13, with an extended period of LOC or the presence of a neurological deficit. Severe (and critical) TBI is defined as GCS 3–8 [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian journal of trauma, resuscitation and emergency medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
