Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients

Mower, William R.; Hoffman, Jerome R.; Herbert, Mel; Wolfson, Allan B.; Pollack, Charles V.; Zucker, Michael I.

doi:10.1097/01.ta.0000187813.79047.42

Cited by 152 publications

(136 citation statements)

References 16 publications

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“…The design and patient characteristics of the 19 studies (representing 22 articles) 26,27,29,46,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] that evaluated the diagnostic performance of clinical decision rules for identifying ICI or need for neurosurgery in adults with MHI are summarised in Table 2. Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark. 56 Six were multicentre studies.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…56 Six were multicentre studies. 26,46,62,[66][67][68][69][70] Cohorts ranged in size from 168 63 to 13,728. 62 Fourteen studies derived a new rule.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…26,46,62,[66][67][68][69][70] Cohorts ranged in size from 168 63 to 13,728. 62 Fourteen studies derived a new rule. 26,27,29,[54][55][56]60,[61][62][63][64]66,67,69 Four studies 46,57,60,[68][69][70][71] reported validation results for more than one rule in the same cohort.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

112

114

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTADiagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA...

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Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…56 Six were multicentre studies. 26,46,62,[66][67][68][69][70] Cohorts ranged in size from 168 63 to 13,728. 62 Fourteen studies derived a new rule.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

112

114

View full text Add to dashboard Cite

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“…25 Similar sensitivity and specificity are given for the New Orleans Criteria, National Emergency X-Ray Utilization Study-II, and Miller Criteria. 5,15,16 More recent studies compared the specific CT head rules with the aim of finding the best rule to reduce the number of ordered CT scans. Stiell et al reevaluated their 2001 study prospectively and found that the use of the CCHR in patients with head trauma resulted in a CT rate of 52.1%.…”

mentioning

confidence: 99%

Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

Wolf¹,

Machold

Frantal

et al. 2014

JNS

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Object This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR). Methods This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma. Results Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%. Conclusions The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

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Use of Clinical Prediction Rules for Guiding Use of Computed Tomography in Adults With Head Trauma

Rivara

Kuppermann

Ellenbogen

2015

JAMA

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Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients

Abstract: Clinical characteristics can reliably identify patients who are unlikely to have intracranial injuries and who do not require CT imaging.

Cited by 152 publications

References 16 publications

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

Use of Clinical Prediction Rules for Guiding Use of Computed Tomography in Adults With Head Trauma

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