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A proposed amendment to the current guidelines for mild traumatic brain injury : reducing computerized tomographies while maintaining safety

Vedin, Tomas LU ; Karlsson, Mathias ; Edelhamre, Marcus LU ; Clausen, Linus ; Svensson, Sebastian LU ; Bergenheim, Mikael and Larsson, Per Anders LU (2019) In European Journal of Trauma and Emergency Surgery
Abstract

Purpose: Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention. Methods: A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were... (More)

Purpose: Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention. Methods: A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived “low-risk proposal” and applied retrospectively to the cohort. Results: Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention. Conclusion: For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.

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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Brain injuries, Intracranial hemorrhage, Practice guidelines as topic, Tomography, Traumatic, X-ray computed
in
European Journal of Trauma and Emergency Surgery
publisher
Urban & Vogel
external identifiers
  • pmid:31089789
  • scopus:85065989823
ISSN
1863-9933
DOI
10.1007/s00068-019-01145-x
language
English
LU publication?
yes
id
2523d0ab-57d4-4bd6-be76-ce10362056e3
date added to LUP
2020-04-16 09:12:00
date last changed
2020-07-08 05:15:27
@article{2523d0ab-57d4-4bd6-be76-ce10362056e3,
  abstract     = {<p>Purpose: Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention. Methods: A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived “low-risk proposal” and applied retrospectively to the cohort. Results: Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention. Conclusion: For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.</p>},
  author       = {Vedin, Tomas and Karlsson, Mathias and Edelhamre, Marcus and Clausen, Linus and Svensson, Sebastian and Bergenheim, Mikael and Larsson, Per Anders},
  issn         = {1863-9933},
  language     = {eng},
  month        = {01},
  publisher    = {Urban & Vogel},
  series       = {European Journal of Trauma and Emergency Surgery},
  title        = {A proposed amendment to the current guidelines for mild traumatic brain injury : reducing computerized tomographies while maintaining safety},
  url          = {http://dx.doi.org/10.1007/s00068-019-01145-x},
  doi          = {10.1007/s00068-019-01145-x},
  year         = {2019},
}