Accuracy of Canadian CT Head Rule and New Orleans Criteria for Minor Head Trauma; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
1 Dey 2020
,
Page e79
https://doi.org/10.22037/aaem.v8i1.902
Abstract
Introduction: The present meta-analysis has two objectives; primarily, the predictive values of Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) will be compared. Secondly, the possibility of interchangeable use of the two models in cases of counterindication will be evaluated.
Methods: An extensive search was performed in Medline, Embase, Scopus and Web of Science electronic databases from the inception of databases until the end of July 2020. All prospective and retrospective observational and diagnostic accuracy studies, performing a comparison between the two models of NOC and CCHR on a single group of patients, were included. Data were entered to the STATA 14.0 statistical program, and analyses were performed using “metandi” command.
Results: Data from 14 articles were included (21140 samples). Summary sensitivity, specificity and diagnostic odds ratio of CCHR in prediction of CT positive findings were 89.8% (95% CI: 79.6 to 95.2), 38.3 (95% CI: 34.0 to 42.8), 5.5 (95% 2.3 to 13.1), respectively. In addition, Summary sensitivity, specificity and diagnostic odds ratio of NOC in prediction of CT positive findings were 97.2% (95% CI: 89.7 to 99.2), 12.3 (95% CI: 7.4 to 19.8), 4.8 (95% 1.2 to 18.3), respectively (Table 3 and Figure 2). Summary sensitivity, specificity and diagnostic odds ratio of CCHR in prediction of clinically important TBI (ciTBI) in mild TBI patients were 92.5% (95% CI: 79.5 to 97.5), 40.1 (95% CI: 34.8 to 45.6), 8.3 (95% 2.4 to 29.2), respectively. In addition, Summary sensitivity, specificity and diagnostic odds ratio of NOC in prediction of ciTBI were 98.3% (95% CI: 93.8 to 99.6), 8.5 (95% CI: 4.8 to 14.5), 5.4 (95% CI: 1.5 to 20.0), respectively (Table 3 and Figure 2).
Conclusion: The present meta-analysis demonstrated that both CCHR and NOC scores have a good predictive value in predicting the presence of abnormal findings in CT scan and ciTBI. The similar performance of CCHR and NOC models results in their interchangeable use in cases of contraindication.
- Sensitivity and Specificity; Predictive Value of Tests; Craniocerebral Trauma; Systematic Review; Meta-Analysis
How to Cite
References
Badhiwala JH, Wilson JR, Fehlings MG. Global burden of traumatic brain and spinal cord injury. The Lancet Neurology. 2019;18(1):24-5.
Silverberg ND, Duhaime A-C, Iaccarino MA. Mild Traumatic Brain Injury in 2019-2020. JAMA. 2020;323(2):177-8.
Nakhjavan-Shahraki B, Yousefifard M, Hajighanbari M, Oraii A, Safari S, Hosseini M. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. European journal of trauma and emergency surgery. 2017;43(6):755-62.
Ahmadi S, Yousefifard M. Accuracy of pediatric emergency care applied research network rules in prediction of clinically important head injuries; A systematic review and meta-analysis. International Journal of Pediatrics. 2017;5(12):6285-300.
Fazel M, Ahmadi S, Hajighanbari MJ, Baratloo A, Shahsavarinia K, Hosseini M, et al. Validation of CRASH Model in Prediction of 14-Day Mortality and 6-Month Unfavourable Outcome of Pediatric Traumatic Brain Injury. International Journal of Pediatrics. 2019;7(12):10413-22.
Nakhjavan-Shahraki B, Yousefifard M, Oraii A, Sarveazad A, Hajighanbari MJ, Safari S, et al. Prediction of clinically important traumatic brain injury in pediatric minor head trauma; proposing pediatric traumatic brain injury (PTBI) prognostic rule. International journal of pediatrics. 2017;5(1):4127-35.
Silverberg ND, Gardner AJ, Brubacher JR, Panenka WJ, Li JJ, Iverson GL. Systematic review of multivariable prognostic models for mild traumatic brain injury. Journal of neurotrauma. 2015;32(8):517-26.
Mushkudiani NA, Hukkelhoven CW, Hernández AV, Murray GD, Choi SC, Maas AI, et al. A systematic review finds methodological improvements necessary for prognostic models in determining traumatic brain injury outcomes. Journal of clinical epidemiology. 2008;61(4):331-43.
Hukkelhoven CW, Steyerberg EW, Habbema JDF, Farace E, Marmarou A, Murray GD, et al. Predicting outcome after traumatic brain injury: development and validation of a prognostic score based on admission characteristics. Journal of neurotrauma. 2005;22(10):1025-39.
Webster NJ, Moore N, Stewart F. Reducing Unnecessary Head Computed Tomography in Mild Traumatic Brain Injury. Advanced emergency nursing journal. 2017;39(4):300-8.
Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, et al. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan. SpringerPlus. 2016;5:176.
Sadegh R, Karimialavijeh E, Shirani F, Payandemehr P, Bahramimotlagh H, Ramezani M. Head CT scan in Iranian minor head injury patients: evaluating current decision rules. Emergency radiology. 2016;23(1):9-16.
Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, et al. Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury. World J Emerg Surg. 2014;9:31-.
Chobdari N, Sharifi MD, Kakhki BR, Shamsaei S, Disfani HF, Hashemian AM. Evaluation of sensitivity and the specificity of canadian ct head rule and new orleans criteria in patients with head injury. Australasian Medical Journal. 2018;11(3):171-5.
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;41(8):971-9.
Edmonds M. The Canadian CT Head Rule reduced the need for CT scans more than the New Orleans Criteria in minor head injury. Evidence-based medicine. 2006;11(2):61.
Valle Alonso J, Fonseca Del Pozo FJ, Vaquero Álvarez M, Lopera Lopera E, Garcia Segura M, García Arévalo R. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury in a Spanish hospital. Medicina clinica. 2016;147(12):523-30.
Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. Jama. 2005;294(12):1511-8.
Smits M, Dippel DW, de Haan GG, Dekker HM, Vos PE, Kool DR, 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(12):1519-25.
Bouida W, Marghli S, Souissi S, Ksibi H, Methammem M, Haguiga H, et al. Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Annals of emergency medicine. 2013;61(5):521-7.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of internal medicine. 2011;155(8):529-36.
Foks KA, van den Brand CL, Lingsma HF, van der Naalt J, Jacobs B, de Jong E, et al. External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands. BMJ (Clinical research ed). 2018;362:k3527.
Jones CMC, Harmon C, McCann M, Gunyan H, Bazarian JJ. S100B outperforms clinical decision rules for the identification of intracranial injury on head CT scan after mild traumatic brain injury. Brain injury. 2020;34(3):407-14.
Korley FK, Morton MJ, Hill PM, Mundangepfupfu T, Zhou TT, Mohareb AM, et al. Agreement Between Routine Emergency Department Care and Clinical Decision Support Recommended Care in Patients Evaluated for Mild Traumatic Brain Injury. Academic Emergency Medicine. 2013;20(5):463-9.
Lo WS, Shih YN, Leung CS, Cheung LW, Leung M, Yeung HC, et al. A retrospective study of patients with minor head injury to compare the canadian CT head rule and the new orleans criteria. Hong Kong Journal of Emergency Medicine. 2016;23(1):25-33.
Papa L, Stiell IG, Clement CM, Pawlowicz A, Wolfram A, Braga C, 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 : official journal of the Society for Academic Emergency Medicine. 2012;19(1):2-10.
Ro YS, Shin SD, Holmes JF, Song KJ, Park JO, Cho JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2011;18(6):597-604.
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. Annals of emergency medicine. 2009;53(2):180-8.
Yang XF, Meng YY, Wen L, Wang H. Criteria for Performing Cranial Computed Tomography for Chinese Patients With Mild Traumatic Brain Injury: Canadian Computed Tomography Head Rule or New Orleans Criteria? The Journal of craniofacial surgery. 2017;28(6):1594-7.
Alali AS, Burton K, Fowler RA, Naimark DMJ, Scales DC, Mainprize TG, et al. Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality. Value in Health. 2015;18(5):721-34.
- Abstract Viewed: 455 times
- pdf Downloaded: 225 times
Download Statastics
Make a Submission
SJR
COPE
