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.
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