Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil?

Tan, Desmond Wei; Lim, Annabelle Mei En; Ong, Daniel Yuxuan; Li, Peng; Chan, Yiong Huak; Ibrahim, Irwani; Kuan, Win Sen

doi:10.11622/smedj.2017046

Cited by 16 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(4) Tan et al conducted a retrospective analysis of 349 patients on the compliance and performance of the CCHR. (5) Compliance to the rule was at 71.3%, which was comparable to the rate reported in Canada. Among the 8.6% of patients for whom CT was recommended but not performed, none had clinically significant head injury.…”

supporting

confidence: 70%

Clinical decision rules in emergency care

Lim¹

2018

smedj

View full text Add to dashboard Cite

supporting

confidence: 70%

Clinical decision rules in emergency care

Lim¹

2018

smedj

View full text Add to dashboard Cite

“…Previous research has shown a low compliance with the clinical rules to select TBI patients for head CT, ranging around 15-60%. [33][34][35][36] Physicians are often either unaware of the clinical decision rules or ignore them in clinical practice due to their complexity. 34,36,37 In agreement with past literature, 6,9,38,39 our study found all four clinical decision rules to have excellent NPV but low PPV.…”

Section: Discussionmentioning

confidence: 99%

Comparing blood biomarkers to clinical decision rules to select patients suspected of traumatic brain injury for head computed tomography

et al. 2022

View full text Add to dashboard Cite

Introduction Traumatic brain injury (TBI) is a major public health concern in the U.S. Recommendations for patients admitted in the emergency department (ED) to receive head computed tomography (CT) scan are currently guided by various clinical decision rules. Objective To compare how a blood biomarker approach compares with clinical decision rules in terms of predicting a positive head CT in adult patients suspected of TBI. Methods We retrospectively identified patients transported to our emergency department and underwent a noncontrast head CT due to suspicion of TBI and who had blood samples available. Published thresholds for serum and plasma glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), and serum S100β were used to make CT recommendations. These blood biomarker-based recommendations were compared to those achieved under widely used clinical head CT decision rules (Canadian, New Orleans, NEXUS II, and ACEP Clinical Policy). Results Our study included 463 patients, of which 122 (26.3%) had one or more abnormalities presenting on head CT. Individual blood biomarkers achieved high negative predictive value (NPV) for abnormal head CT findings (88%–98%), although positive predictive value (PPV) was consistently low (25%–42%). A composite biomarker-based decision rule (GFAP+UCH-L1)’s NPV of 100% and PPV of 29% were comparable or better than those achieved under the clinical decision rules. Conclusion Blood biomarkers perform at least as well as clinical rules in terms of selecting TBI patients for head CT and may be easier to implement in the clinical setting. A prospective study is necessary to validate this approach.

show abstract

“…27,28 Although the Canadian head CT rule and the New Orleans Criteria offer some guidelines, they primarily rely on additional methods to support the evaluation of TBIs. [29][30][31] Hence, when a patient presents with facial trauma, which is common among TBI patients, measuring both ONSD and ONST may prove necessary to help clinicians decide whether to request additional brain CTs. Based on the results of the present study, we recommend that ONST on sagittal facial CT images be assessed prior to prescribing any additional brain CT, especially when novice EPs are involved in the patient's care.…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients without suspected TBI, additional radiologic evaluation may not be required, because of the risk of increased radiation exposure, especially among vulnerable patients such as children and pregnant women, followed by an increase in medical costs [ 27 , 28 ]. Although the Canadian head CT rule and the New Orleans Criteria offer some guidelines, they primarily rely on additional methods to support the evaluation of TBIs [ 29 - 31 ]. Hence, when a patient presents with facial trauma, which is common among TBI patients, measuring both ONSD and ONST may prove necessary to help clinicians decide whether to request additional brain CTs.…”

Section: Discussionmentioning

confidence: 99%

Comparative and retrospective evaluation of the predictive performance of optic nerve sheath thickness and optic nerve sheath diameter for traumatic brain injury using facial computed tomography

Sim

Lee

Yun³

et al. 2020

Clin Exp Emerg Med

View full text Add to dashboard Cite

Objective To evaluate the predictive performance of optic nerve sheath thickness (ONST) on the outcomes of traumatic brain injury (TBI) and to compare the inter-observer agreement To evaluate the predictive performance of optic nerve sheath thickness (ONST) for traumatic brain injury (TBI) and to compare the predictive performance and inter-observer agreement between ONST and optic nerve sheath diameter (ONSD) on facial computed tomography (CT). Methods We retrospectively enrolled patients with a history of facial trauma and who underwent both facial CT and brain CT. Two reviewers independently measured ONST and ONSD of each patient using facial CT images. Final brain CT with clinical outcome was used as the reference standard for TBI. Multivariate logistic regression analyses, receiver operating characteristic (ROC) curves, and intraclass correlation coefficients were used for statistical analyses. Results Both ONST (P = 0.002) and ONSD (P = 0.001) on facial CT were significantly independent factors to distinguish between TBI and healthy brains; an increase in ONST and ONSD values corresponded with an increase in the risk of TBI by 8.9-and 7.6-fold, respectively. The predictive performances of the ONST (sensitivity, 96.2%; specificity, 94.3%; area under the ROC curve, 0.968) and ONSD (sensitivity, 92.6%; specificity, 90.2%; area under the ROC curve, 0.955) were excellent and exhibited similar sensitivity, specificity, and area under the curve (P = 0.18-0.99). Interobserver and intraobserver intraclass correlation coefficients for ONST were significantly higher than those for ONSD (all P < 0.001). Conclusion ONST on facial CT is a feasible predictor of TBI and demonstrates similar performance and superior observer agreement than ONSD. We recommend using ONST measurements to assess the need for additional brain CT scans in TBI-suspected cases.

show abstract

Computed tomography of the head for adult patients with minor head injury: are clinical decision rules a necessary evil?

Abstract: Compliance with the CCHR for adult patients with minor head injury remains low in the ED. A qualitative review of physicians' practices and patients' preferences may be carried out to evaluate reasons for noncompliance.

Cited by 16 publications

References 21 publications

Clinical decision rules in emergency care

Clinical decision rules in emergency care

Comparing blood biomarkers to clinical decision rules to select patients suspected of traumatic brain injury for head computed tomography

Comparative and retrospective evaluation of the predictive performance of optic nerve sheath thickness and optic nerve sheath diameter for traumatic brain injury using facial computed tomography

Contact Info

Product

Resources

About