Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan

Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Yumiko Kato, Yasuko Tatewaki, Kei Takase, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi, Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Yumiko Kato, Yasuko Tatewaki, Kei Takase, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi

Abstract

We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13-15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient's score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings. Only the Canadian was significantly associated with important CT findings in multivariate analyses and showed higher area under the receiver operating characteristic curve (AUC) either in all 142 patients (GCS 13-15: P = 0.0130; AUC = 0.69) or in the 67 with a GCS = 15 (P = 0.0128, AUC = 0.73). Of items, ">60 years" or "≥65 years" included in either guideline was the strongest predictor of important CT finding, followed by "GCS < 15 after 2 h" included only in the CCHR. In a tertiary referral hospital in Japan, CCHR had higher performance than the NOC in predicting important CT findings.

Keywords: Canadian computed tomography (CT) head rule; Computed tomography (CT); Mild traumatic brain injury; New Orleans Criteria; Traumatic brain injury.

Figures

Fig. 1
Fig. 1
A 42-year-old man who was hit by a car while riding a bicycle. His GCS on admission to the emergency room was 14 out of 15. Two hours after admission, the patient’s GCS remained the same. The patient showed any of the New Orleans guideline’s items, therefore, his New Orleans score was 0. This is in contrast to the Canadian guideline, in which the patient had a GCS score of less than 15 at 2 h after admission (scored +1) and his mechanism of accident (car versus bicycle) fits the dangerous mechanism item (scored +1), leading to a Canadian Score of 2. On CT, the patients shows acute subarachnoid hemorrhages in the left Sylvian fissure (left panel, arrow) and on the surface of the left frontal lobe (middle, arrow). More importantly, some hyperdense foci that are suspected to represent a diffuse axonal injury are seen in the corpus callosum (middle panel, dashed arrow). The follow-up MRI study performed later, confirms the presence of DAI lesions on T2*WI (right panel, dashed arrow)

References

    1. Af Geijerstam JL, Britton M. Mild head injury: reliability of early computed tomographic findings in triage for admission. Emerg Med J. 2005;22:103–107. doi: 10.1136/emj.2004.015396.
    1. Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG, WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004;43(43 Suppl):113–125. doi: 10.1080/16501960410023877.
    1. Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG, WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004;36(43 Suppl):28–60. doi: 10.1080/16501960410023732.
    1. Fabbri A, Servadei F, Marchesini G, et al. Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury. J Neurol Neurosurg Psychiatry. 2004;75:410–416. doi: 10.1136/jnnp.2003.016113.
    1. González AB, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363:345–351. doi: 10.1016/S0140-6736(04)15433-0.
    1. Harnan SE, Pickering A, Pandor A, et al. Clinical decision rules for adults with minor head injury: a systematic review. J Trauma. 2011;71:245–251. doi: 10.1097/TA.0b013e31820d090f.
    1. Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343:100–105. doi: 10.1056/NEJM200007133430204.
    1. Kavalci C, Aksel G, Salt O, et al. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury. World J Emerg Surg. 2014;9:31. doi: 10.1186/1749-7922-9-31.
    1. Mata-Mbemba D, Mugikura S, Nakagawa A, et al. Early CT findings to predict early death at hospital discharge in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the tertiary referral hospital in northeastern Japan. Acad Radiol. 2014;21:605–611. doi: 10.1016/j.acra.2014.01.017.
    1. Mata-Mbemba D, Mugikura S, Nakagawa A, et al. Intraventricular hemorrhage on initial computed tomography as marker of diffuse axonal injury after traumatic brain injury. J Neurotrauma. 2015;32:359–365. doi: 10.1089/neu.2014.3453.
    1. Nakajima Y, Yamada K, Imamura K, et al. Radiologist supply and workload: international comparison—working group of Japanese College of Radiology. Radiat Med. 2008;26:455–465. doi: 10.1007/s11604-008-0259-2.
    1. Novikov I, Fund N, Freedman LS. A modified approach to estimating sample size for simple logistic regression with one continuous covariate. Stat Med. 2010;29:97–107.
    1. Papa L, Stiell IG, Clement CM, et al. Performance of the Canadian CT head rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med. 2012;19:2–10. doi: 10.1111/j.1553-2712.2011.01247.x.
    1. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379. doi: 10.1016/S0895-4356(96)00236-3.
    1. Smits M, Dippel DW, de Haan GG, et al. External validation of the Canadian CT head rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294:1519–1525. doi: 10.1001/jama.294.12.1519.
    1. Smits M, Dippel DW, Steyerberg EW, et al. Predicting intracranial traumatic findings on computed tomography in patients with head injury: the CHIP prediction rule. Ann Intern Med. 2007;146:397–405. doi: 10.7326/0003-4819-146-6-200703200-00004.
    1. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391–1396. doi: 10.1016/S0140-6736(00)04561-X.
    1. Stiell IG, Clement CM, Rowe BH, et al. Comparison of the Canadian CT head rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294:1511–1518. doi: 10.1001/jama.294.12.1511.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere