Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children
Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children
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DOI：
10.1136/adc.2005.083980
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发表时间：
2006-11-01
影响因子：
5.2
通讯作者：
Mackway-Jones, K.
中科院分区：
文献类型：
--
作者：
Dunning, J.;Daly, J. Patrick;Mackway-Jones, K.
背景：到急诊科就诊的所有患者中有四分之一是儿童。虽然有几项大型的、进行得很好的成人研究，能够准确地选择高危颅脑损伤患者进行CT扫描，但没有这样的研究得出适用于儿童的规则。目的：进行前瞻性多中心诊断队列研究，为选择高危颅脑损伤儿童进行CT扫描提供规则。设计：招募所有到英格兰西北部10家医院急诊科就诊的任何严重颅脑损伤的儿童。一份量身定做的表格被用来收集每个孩子大约40个临床变量的数据。这些变量是从文献综述中定义的，在儿童头部损伤算法预测重要临床事件(圣杯)研究之前进行了一项先导性研究。所有有临床意义的头部损伤(死亡、需要神经外科干预或计算机断层扫描异常)的儿童都被识别出来。结果：在21岁半的时间里，共招募了22 772名儿童。其中65%是男孩，56%是5岁。281名儿童在计算机断层扫描中出现异常，137名儿童接受了神经外科手术，15名儿童死亡。圣杯规则预测临床意义重大颅脑损伤的敏感性为98%(95%可信区间为96%~100%)，特异性为87%(95%可信区间为86%~87%)，并要求CT扫描率为14%。结论：建立了一个高度敏感的临床决策规则，用于确定儿童颅脑损伤后应接受CT扫描的患者。这一规定有可能改善和标准化对头部受伤儿童的护理。现在应该在新的患者队列中验证这一规则。
Background: A quarter of all patients presenting to emergency departments are children. Although there are several large, well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children.Aim: To conduct a prospective multicentre diagnostic cohort study to provide a rule for selection of high-risk children with head injury for computed tomography scanning.Design: All children presenting to the emergency departments of 10 hospitals in the northwest of England with any severity of head injury were recruited. A tailor-made proforma was used to collect data on around 40 clinical variables for each child. These variables were defined from a literature review, and a pilot study was conducted before the children's head injury algorithm for the prediction of important clinical events (CHALICE) study. All children who had a clinically significant head injury (death, need for neurosurgical intervention or abnormality on a computed tomography scan) were identified. Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology.Results: 22 772 children were recruited over 21/2 years. 65% of these were boys and 56% were < 5 years old. 281 children showed an abnormality on the computed tomography scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%.Conclusion: A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care of children presenting with head injuries. Validation of this rule in new cohorts of patients should now be undertaken.