The Canadian CT head rule for patients with minor head injury
The Canadian CT head rule for patients with minor head injury
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DOI：
10.1016/s0140-6736(00)04561-x
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发表时间：
2001-05-05
期刊：
影响因子：
168.9
通讯作者：
Worthington, J
中科院分区：
文献类型：
--
作者：
Stiell, IG;Wells, GA;Worthington, J
背景对于轻微脑损伤患者使用计算机断层扫描（CT）有很多争议。我们的目的是开发一个高度敏感的临床决策规则使用CT在轻微的头部injuries.Methods患者，我们进行了这项前瞻性队列研究，在急诊室的10个大型加拿大医院，包括连续成人谁提出了格拉斯哥昏迷量表（GCS）评分为13-15头部injuries. Methods后。我们在CT扫描前进行了标准化的临床评估。主要结果的措施是需要神经系统干预和临床上重要的脑损伤CT。结果-3121例患者有以下特点：平均年龄38.7岁）; GCS评分13（3.5%），14（16.7%），15（79.8%）; 8%有临床上重要的脑损伤;和1%需要神经系统干预。我们推导出了一个CT头部规则，其中包括5个高危因素（2小时内未能达到GCS 15，怀疑开放性颅骨骨折，任何颅底骨折的迹象，呕吐≥ 2次，或年龄≥ 65岁）和2个额外的中等风险因素（撞击前遗忘≥ 30分钟和损伤的危险机制）。高危因素对预测神经系统干预需求的敏感性为100%（95% CI 92-100%），仅需要32%的患者接受CT检查。中等风险因素的敏感性为98.4%（95%CI 96-99%）和49.6%的特异性预测临床上重要的脑损伤，并只需要54%的患者接受CT。解释我们已经开发了加拿大CT头规则，一个高度敏感的决策规则使用CT。这一规则有可能显着提高和改善轻微颅脑损伤患者的急诊管理。
Background There is much controversy about the use of computed tomography (CT) for patients with minor head injury. We aimed to develop a highly sensitive clinical decision rule for use of CT in patients with minor head injuries.Methods We carried out this prospective cohort study in the emergency departments of ten large Canadian hospitals and included consecutive adults who presented with a Glasgow Coma Scale (GCS) score of 13-15 after head injury. We did standardised clinical assessments before the CT scan. The main outcome measures were need for neurological intervention and clinically important brain injury on CT.Findings The 3121 patients had the following characteristics: mean age 38.7 years); GCS scores of 13 (3.5%), 14 (16.7%), 15 (79.8%); 8% had clinically important brain injury; and 1% required neurological intervention. We derived a CT head rule which consists of five high-risk factors (failure to reach GCS of 15 within 2 h, suspected open skull fracture, any sign of basal skull fracture, vomiting greater than or equal to2 episodes, or age greater than or equal to 65 years) and two additional medium-risk factors (amnesia before impact greater than or equal to 30 min and dangerous mechanism of injury). The high-risk factors were 100% sensitive (95% CI 92-100%) for predicting need for neurological intervention, and would require only 32% of patients to undergo CT. The medium-risk factors were 98.4% sensitive (95% CI 96-99%) and 49.6% specific for predicting clinically important brain injury, and would require only 54% of patients to undergo CT.Interpretation We have developed the Canadian CT Head Rule, a highly sensitive decision rule for use of CT. This rule has the potential to significantly standardise and improve the emergency management of patients with minor head injury.