Abstract
We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13–15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient’s score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13–15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, “>60 years” or “≥65 years” included in either guideline was the strongest predictor of important CT finding, followed by “GCS < 15 after 2 h” included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-1781-9) contains supplementary material, which is available to authorized users.
Highlights
Mild traumatic brain injury (TBI) is a common neurological disorder in western countries with an estimated incidence of [100–300] per 100,000 people (Cassidy et al 2004)
We aimed to compare the performance of the computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) guidelines in predicting important computed tomography (CT) findings in Japanese patients with mild TBI, by introducing two scoring systems derived from the CCHR or the NOC in an attempt to weigh the contribution of individual clinical items to the overall performance of each guideline, which has never been investigated to our knowledge
142 consecutive patients with mild TBI (GCS 13–15) who were admitted to our institution, the major tertiary care hospital in northeastern Japan, in 2009 and 2010 (6) and who fulfilled the following criteria were included in the current study: (a) recent history (
Summary
Mild traumatic brain injury (TBI) is a common neurological disorder in western countries with an estimated incidence of [100–300] per 100,000 people (Cassidy et al 2004). Mild TBI is commonly defined as a blunt injury to the head that results in a normal or minimally altered level of consciousness in the patient at presentation to the emergency department i.e., a Glasgow Coma scale (GCS) score of [13–15], and loss of consciousness for ≤15 min, or posttraumatic amnesia for ≤60 min, or both (Carroll et al 2004). A GCS of 15 out of 15 suggests normal neurological function. After mild TBI, intracranial complications are sometimes detected on computed tomography (CT) requiring hospitalization or neurosurgical intervention (important CT findings) (Fabbri et al 2004; Af Geijerstam and Britton 2005). CT plays a crucial role for reliable and rapid diagnosis of such complications (MataMbemba et al 2014, 2015). Excessive use of CT increases unnecessary irradiation, while overly conservative usage can lead to missing life-threatening lesions
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