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Application of NICE or SNC guidelines may reduce the need for computerized tomographies in patients with mild traumatic brain injury : A retrospective chart review and theoretical application of five guidelines

Svensson, Sebastian LU ; Vedin, Tomas LU ; Clausen, Linus ; Larsson, Per Anders LU and Edelhamre, Marcus LU (2019) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 27(1).
Abstract

Background: Traumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide. Most traumatic brain injuries are classified as mild, with a low but not negligible risk of intracranial hemorrhage. To help physicians decide which patients might benefit from a computerized tomography (CT) of the head to rule out intracranial hemorrhage, several clinical decision rules have been developed and proven effective in reducing the amount of negative CTs, but they have not been compared against one another in the same cohort as to which one demonstrates the best performance. Methods: This study involved a retrospective review of the medical records of patients seeking care between January 1 and December 31, 2017 at... (More)

Background: Traumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide. Most traumatic brain injuries are classified as mild, with a low but not negligible risk of intracranial hemorrhage. To help physicians decide which patients might benefit from a computerized tomography (CT) of the head to rule out intracranial hemorrhage, several clinical decision rules have been developed and proven effective in reducing the amount of negative CTs, but they have not been compared against one another in the same cohort as to which one demonstrates the best performance. Methods: This study involved a retrospective review of the medical records of patients seeking care between January 1 and December 31, 2017 at Helsingborg Hospital, Sweden after head trauma. The Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), the National Emergency X-Radiography Utilization Study II (NEXUS II), the National Institute of Health and Care Excellence (NICE) guideline and the Scandinavian Neurotrauma Committee (SNC) guideline were analyzed. A theoretical model for each guideline was constructed and applied to the cohort to yield a theoretical CT-rate for each guideline. Performance parameters were calculated and compared. Results: One thousand three hundred fifty-three patients were included; 825 (61%) CTs were performed, and 70 (5.2%) cases of intracranial hemorrhage were found. The CCHR and the NOC were applicable to a minority of the patients, while the NEXUS II, the NICE, and the SNC guidelines were applicable to the entire cohort. A theoretical application of the NICE and the SNC guidelines would have reduced the number of CT scans by 17 and 9% (P = < 0.0001), respectively, without missing patients with intracranial hemorrhages requiring neurosurgical intervention. Conclusion: A broad application of either NICE or the SNC guidelines could potentially reduce the number of CT scans in patients suffering from mTBI in a Scandinavian setting, while the other guidelines seemed to increase the CT frequency. The sensitivity for intracranial hemorrhage was lower than in previous studies for all guidelines, but no fatality or need for neurosurgical intervention was missed by any guideline when they were applicable.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
27
issue
1
article number
99
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85074549245
  • pmid:31684991
ISSN
1757-7241
DOI
10.1186/s13049-019-0673-8
language
English
LU publication?
yes
id
2060b503-e933-4e18-8424-06fc64400dab
date added to LUP
2019-11-18 13:33:23
date last changed
2024-05-29 03:49:03
@article{2060b503-e933-4e18-8424-06fc64400dab,
  abstract     = {{<p>Background: Traumatic brain injuries continue to be a significant cause of mortality and morbidity worldwide. Most traumatic brain injuries are classified as mild, with a low but not negligible risk of intracranial hemorrhage. To help physicians decide which patients might benefit from a computerized tomography (CT) of the head to rule out intracranial hemorrhage, several clinical decision rules have been developed and proven effective in reducing the amount of negative CTs, but they have not been compared against one another in the same cohort as to which one demonstrates the best performance. Methods: This study involved a retrospective review of the medical records of patients seeking care between January 1 and December 31, 2017 at Helsingborg Hospital, Sweden after head trauma. The Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), the National Emergency X-Radiography Utilization Study II (NEXUS II), the National Institute of Health and Care Excellence (NICE) guideline and the Scandinavian Neurotrauma Committee (SNC) guideline were analyzed. A theoretical model for each guideline was constructed and applied to the cohort to yield a theoretical CT-rate for each guideline. Performance parameters were calculated and compared. Results: One thousand three hundred fifty-three patients were included; 825 (61%) CTs were performed, and 70 (5.2%) cases of intracranial hemorrhage were found. The CCHR and the NOC were applicable to a minority of the patients, while the NEXUS II, the NICE, and the SNC guidelines were applicable to the entire cohort. A theoretical application of the NICE and the SNC guidelines would have reduced the number of CT scans by 17 and 9% (P = &lt; 0.0001), respectively, without missing patients with intracranial hemorrhages requiring neurosurgical intervention. Conclusion: A broad application of either NICE or the SNC guidelines could potentially reduce the number of CT scans in patients suffering from mTBI in a Scandinavian setting, while the other guidelines seemed to increase the CT frequency. The sensitivity for intracranial hemorrhage was lower than in previous studies for all guidelines, but no fatality or need for neurosurgical intervention was missed by any guideline when they were applicable.</p>}},
  author       = {{Svensson, Sebastian and Vedin, Tomas and Clausen, Linus and Larsson, Per Anders and Edelhamre, Marcus}},
  issn         = {{1757-7241}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}},
  title        = {{Application of NICE or SNC guidelines may reduce the need for computerized tomographies in patients with mild traumatic brain injury : A retrospective chart review and theoretical application of five guidelines}},
  url          = {{http://dx.doi.org/10.1186/s13049-019-0673-8}},
  doi          = {{10.1186/s13049-019-0673-8}},
  volume       = {{27}},
  year         = {{2019}},
}