Clinical decision rules for the indication of computed tomography in adults with minor head injury

DOI Open Access
  • lnaka Aki
    Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine
  • Kimura Akio
    Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine
  • Hagiwara Akiyoshi
    Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine
  • Sasaki Ryo
    Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine
  • Kobayashi Kentarou
    Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine
  • lnoue Masato
    Department of Neurosurgery, National Center for Global Health and Medicine
  • Shinbo Takuro
    Department of Clinical Research and Informatics, National Center for Global Health and Medicine

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Other Title
  • 軽症頭部外傷患者における頭部CT適応基準の作成と検証

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Objective: The objective of the present study is to create clinical decision rules for head computed tomography (CT) that enable highly sensitive detection of intracranial hemorrhage requiring hospitalization or surgery, and highly specific diagnosis.<BR>Methods: Patients with Minor Head Injuries (MHI) who presented with Glasgow coma scale (GCS) score of 15 who visited the emergency department of our center between January 1, 2006 and March 31, 2010 were retrospectively investigated with regard to 11 predictor candidates. Patients were divided into younger (16 to 59 years of age) and elderly (360 years of age) groups for analysis. Using the period from January 1, 2006 to December 31, 2007 as the derivation period, univariate analysis was performed for the 11 predictor candidates using positive (CT abnormality present) and negative (absent) results on head CT as the outcome. Factors with significant differences were identified and recursive partitioning analysis was used to determine the smallest combination of prognostic factors that yielded a sensitivity of 100% for positive results on head CT. Based on the results, clinical decision rules focusing on the necessity of CT were created. In addition, using the period from February 1, 2008 to March 31, 2010 as the data validation period, the validity of the prognostic factors derived above was determined using recursive partitioning.<BR>Results: In the younger group, sensitivity for positive results on head CT was 100% when they have any of the following three predictors: receiving oral Anticoagulant and/or Antiplatelet therapy, transient loss of consciousness (LOC) and/or amnesia, and Wound over clavicular to head. In the elderly group, sensitivity for positive results on head CT was 100% when they have any of the following three predictors: receiving oral Anticoagulant and/or Antiplatelet therapy, transient LOC and/or amnesia, and diffuse headache.<BR>Discussion: By creating age-specific clinical decision rules, it may be possible to reduce the number of head CT taken for MHI without overlooking patients who have clinically important intracranial injuries using fewer predictors than in previous studies.

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