 |
|
External Validation of the Canadian CT Head Rule and the New Orleans Criteria for CT Scanning in Patients With Minor Head Injury
Marion Smits, MD;
Diederik W. J. Dippel, MD, PhD;
Gijs G. de Haan, MD;
Heleen M. Dekker, MD;
Pieter E. Vos, MD, PhD;
Digna R. Kool, MD;
Paul J. Nederkoorn, MD, PhD;
Paul A. M. Hofman, MD, PhD;
Albert Twijnstra, MD, PhD;
Hervé L. J. Tanghe, MD;
M. G. Myriam Hunink, MD, PhD
JAMA. 2005;294:1519-1525.
Context Two decision rules for indications of computed tomography (CT) in patients with minor head injury, the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC), suggest that CT scanning may be restricted to patients with certain risk factors, which would lead to important reductions in the use of CT scans.
Objective To validate and compare these 2 published decision rules in Dutch patients with head injuries.
Design, Setting, and Patients A prospective multicenter study conducted between February 11, 2002, and August 31, 2004, in 4 university hospitals in the Netherlands of 3181 consecutive adult patients with minor head injury who presented with a Glasgow Coma Scale (GCS) score of 13 to 14 or with a GCS score of 15 and at least 1 risk factor.
Main Outcome Measures Primary outcome was any neurocranial traumatic finding on CT scan. Secondary outcomes were neurosurgical intervention and clinically important CT findings. Sensitivity and specificity were estimated for each outcome for the CCHR and the NOC, using both rules as originally derived and also as adapted to apply to an expanded patient population.
Results Of 3181 patients with a GCS score of 13 to 15, neurosurgical intervention was performed in 17 patients (0.5%); neurocranial traumatic CT findings were present in 312 patients (9.8%). Sensitivity for neurosurgical intervention was 100% for both the CCHR and the NOC. The NOC had a higher sensitivity for neurocranial traumatic findings and for clinically important findings (97.7%-99.4%) than did the CCHR (83.4%-87.2%). Specificities were very low for the NOC (3.0%-5.6%) and higher for the CCHR (37.2%-39.7%). The estimated potential reduction in CT scans for patients with minor head injury would be 3.0% for the adapted NOC and 37.3% for the adapted CCHR.
Conclusions For patients with minor head injury and a GCS score of 13 to 15, the CCHR has a lower sensitivity than the NOC for neurocranial traumatic or clinically important CT findings, but would identify all cases requiring neurosurgical intervention, and has greater potential for reducing the use of CT scans.
Author Affiliations: Departments of Radiology (Drs Smits, Tanghe, and Hunink), Neurology (Dr Dippel), Medical Informatics (Dr de Haan), and Epidemiology and Biostatistics (Dr Hunink), Erasmus MC– University Medical Centre, Rotterdam; Departments of Radiology (Dr Dekker) and Neurology (Dr Vos), University Medical Centre Nijmegen St Radboud, Nijmegen; Departments of Radiology (Dr Kool) and Neurology (Dr Nederkoorn), Academic Medical Centre, Amsterdam; and Departments of Radiology (Dr Hofman) and Neurology (Dr Twijnstra), University Hospital Maastricht, Maastricht, the Netherlands.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
CT Scanning for Minor Head Injury
Eric Schwam
JAMA. 2006;295(5):497.
EXTRACT
| FULL TEXT
CT Scanning for Minor Head Injury—Reply
Marion Smits, Diederik W. J. Dippel, and M. G. Myriam Hunink
JAMA. 2006;295(5):497-498.
EXTRACT
| FULL TEXT
CT Scanning for Minor Head Injury
Ian G. Stiell, Catherine M. Clement, Brian H. Rowe, Robert Brison, and George A. Wells
JAMA. 2006;295(5):498.
EXTRACT
| FULL TEXT
RELATED ARTICLES
Comparison of the Canadian CT Head Rule and the New Orleans Criteria in Patients With Minor Head Injury
Ian G. Stiell, Catherine M. Clement, Brian H. Rowe, Michael J. Schull, Robert Brison, Daniel Cass, Mary A. Eisenhauer, R. Douglas McKnight, Glen Bandiera, Brian Holroyd, Jacques S. Lee, Jonathan Dreyer, James R. Worthington, Mark Reardon, Gary Greenberg, Howard Lesiuk, Iain MacPhail, and George A. Wells
JAMA. 2005;294(12):1511-1518.
ABSTRACT
| FULL TEXT
Clinical Decision Instruments for CT Scanning in Minor Head Injury
Micelle J. Haydel
JAMA. 2005;294(12):1551-1553.
EXTRACT
| FULL TEXT
Head Injury
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2005;294(12):1580.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Rising Use Of Diagnostic Medical Imaging In A Large Integrated Health System
Smith-Bindman et al.
Health Aff (Millwood) 2008;27:1491-1502.
ABSTRACT
| FULL TEXT
A Clinical Decision Rule for Cranial Computed Tomography in Minor Pediatric Head Trauma
Atabaki et al.
Arch Pediatr Adolesc Med 2008;162:439-445.
ABSTRACT
| FULL TEXT
Outcome after Complicated Minor Head Injury
Smits et al.
Am. J. Neuroradiol. 2008;29:506-513.
ABSTRACT
| FULL TEXT
Minor Head Injury: Guidelines for the Use of CT A Multicenter Validation Study
Smits et al.
Radiology 2007;245:831-838.
ABSTRACT
| FULL TEXT
Head Trauma
Davis and for the Expert Panel on Neurologic Imaging
Am. J. Neuroradiol. 2007;28:1619-1621.
FULL TEXT
Predicting Intracranial Traumatic Findings on Computed Tomography in Patients with Minor Head Injury: The CHIP Prediction Rule
Smits et al.
ANN INTERN MED 2007;146:397-405.
ABSTRACT
| FULL TEXT
Concussion
Ropper and Gorson
NEJM 2007;356:166-172.
FULL TEXT
The Canadian CT Head Rule reduced the need for CT scans more than the New Orleans Criteria in minor head injury
Edmonds
Evid. Based Med. 2006;11:61-61.
FULL TEXT
CT Scanning for Minor Head Injury
Schwam
JAMA 2006;295:497-497.
FULL TEXT
Minor Blunt Head-Injury Rules: Which Is the Winner?
JWatch Emergency Med. 2005;2005:7-7.
FULL TEXT
Clinical Decision Instruments for CT Scanning in Minor Head Injury
Haydel
JAMA 2005;294:1551-1553.
FULL TEXT
|
