ACEP's Recommendations for Brain Computed Tomography Scan in Adult Minor Head Trauma Patients; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
1 January 2020
,
Page e86
https://doi.org/10.22037/aaem.v8i1.790
Abstract
Introduction: Some clinical decision rules have been developed to identify minor head trauma (MHT) patients in need of brain computed tomography (CT) scan for detection of possible traumatic brain injuries (TBIs). This study aimed to evaluate the performance of American College of Emergency Physicians (ACEP) recommendations in this regard.
Methods: This study is a cross-sectional study of MHT (GCS: 13-15) cases who referred to emergency department of a level one trauma center, Mashhad, Iran, from October 2017 to March 2018. The screening performance characteristics of ACEP recommendations for performing brain CT scan in these patients were calculated.
Results: 500 patients with a mean age of 37.97 ± 15.96 years were evaluated. Based on level one recommendations, 73 (14.6 %) patients had to be assessed by brain CT scan. 67 (91.8%) were assessed and 6 (8.2%) were not assessed based on decision of their in-charge physician. According to level two recommendations, 125 (25.0%) patients did not need brain CT scan, 85 (68%) of whom had been assessed (all normal). Performing brain CT scan according to the level one recommendation of ACEP’s clinical policy showed 29.6% sensitivity (95% CI: 13.75 to 50.18) and 86.3% specificity (95% CI: 82.68 to 89.14). The overall ACEP’s clinical policy for neuroimaging of adults with MTBI showed sensitivity and specificity of 92.59% (95% CI: 75.71 to 99.09) and 26.4% (95% CI: 22.51 to 30.65), respectively.
Conclusion: ACEP’s clinical policy has a high-level sensitivity for using brain CT scan in detection of probable TBI in patients with MHT.
- Craniocerebral Trauma; Brain; Tomography, X-Ray Computed; Health Planning Guidelines
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Essam A. Elgamal, Sherif M. El-Watidy, Zain A. Jamjoom, Ali Abdel-Raouf, Hamdy Hassan, Hassan Alwaraqi, Sabry Al-Malah, Elgamal, E.A., El-Watidy, S.M., Jamjoom, Z.A. et al. Evaluation of the Canadian CT Head Rule for Minor Head Trauma in a Tertiary Referral Institution. Eur J Trauma (2006) 32: 527. doi:10.1007/s00068-006-5156-8.
Emergency Medicine News. Continuing Medical Education in EMN, Emergency Medicine News: January 2004 - Volume 26 - Issue 13 - p 5. .
Cassidy JD, Carroll L, Peloso P, Borg J, Von Holst H, Holm L, Kraus J, Coronado V. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of rehabilitation medicine. 2004 Feb 1;36(0):28-60. .
Mower WR, Hoffman JR, Herbert M, et al. Developing a clinical decision instrument to rule out intracranial injuries in patients with minor head trauma: Methodology of the NEXUS II investigation. Ann Emerg Med 2002;40:505–14.
Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV Jr, Zucker MI. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005; 59:954–9.
Anish TS, Sreelakshmi PR, Medhavan S, Babu S, Sugathan S. Efficacy of Canadian computed tomography head rule in predicting the need for a computed–axial tomography scans among patients with suspected head injuries. International journal of critical illness and injury science. 2012 Sep;2(3):163.
Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, Takase K, Kushimoto S, Tominaga T, Takahashi S. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan. SpringerPlus. 2016 Dec;5(1):176.
Stiell IG, Clement CM, Rowe BH, et al. Comparison of the Canadian CT head rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005; 294:1511–8.
Stein SC, Fabbri A, Servadei F, Glick HA. A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med. 2009; 53:180–8.
Smits M, Dippel DW, de Haan GG, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005; 294:1519–25.
Rosengren D, Rothwell S, Brown AF, Chu K. The application of North American CT scan criteria to an Australian population with minor head injury. Emerg Med Australas. 2004; 16:195–200.
Ro YS, Shin SD, Holmes JF, Song KJ, Park JO, Cho JS, Lee SC, Kim SC, Hong KJ, Park CB, Cha WC. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Academic Emergency Medicine. 2011 Jun;18(6):597-604.
Abdalla RO, Qureshi MM, Saidi H, Abdallah A Aga Khan . Introduction of the Canadian CT Head Rule Reduces CT Scan Use in Minor Head Injury . The ANNALS of AFRICAN SURGERY. January 2015 Volume 12 Issue 1 19(115-133).
Jagoda AS, Bazarian JJ, Bruns Jr JJ, Cantrill SV, Gean AD, Howard PK, Ghajar J, Riggio S, Wright DW, Wears RL, Bakshy A. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Journal of Emergency Nursing. 2009 Mar 1;35(2):e5-40.
Maguen S, Lau KM, Madden E, Seal K. Factors associated with completing comprehensive traumatic brain injury evaluation. Military medicine. 2012 Jul 1;177(7):797-803.
Hsiao KY, Li WC, Chang CH, Lin MH, Yang JT, Wang PC, Chen KH. An evaluation of the ACEP guideline for mild head injuries in Taiwan. Hong Kong Journal of Emergency Medicine. 2017 Mar;24(2):73-8.
Jagoda AS. Mild traumatic brain injury: key decisions in acute management. Psychiatric Clinics. 2010 Dec 1;33(4):797-806.
Cemil Kaval, GokhanAksel, Omer Salt, M Serkan Yilmaz, Ali Demir, GulsümKavalci, BetulAkbugaOzel, ErtugrulAltinbilek, Tamer Durdu, CihatYel, PolatDurukan , BahattinIsik - Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury - World Journal of Emergency Surgery 2014 9:31, DOI: 10.1186/1749-7922-9-31.
Linda P, Ian GS, Catherine MC, Artur P, Andrew W, Sameer D, et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for Predicting Any Traumatic Intracranial Injury on Computed Tomography in a United States Level I Trauma Center. Academic Emergency Medicine 2012; 19:2–10.
Schachar JL, Zampolin RL, Miller TS, Farinhas JM, Freeman K, Taragin BH. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center. Pediatric radiology. 2011 Aug 1;41(8):971.
Mower WR, Gupta M, Rodriguez R, Hendey GW. Validation of the NEXUS II Pediatric Head Computed Tomography Decision Instrument. The Journal of Emergency Medicine. 2017 Sep 30;53(3):441.
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