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Annals of Emergency Medicine

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Prediction Value of the Canadian CT Head Rule and the New Orleans Criteria for Positive Head CT Scan and Acute Neurosurgical Procedures in Minor Head Trauma: A Multicenter External Validation Study - 24/04/13

Doi : 10.1016/j.annemergmed.2012.07.016 
Wahid Bouida, MD a, Soudani Marghli, MD c, Sami Souissi, MD d, Hichem Ksibi, MD e, Mehdi Methammem, MD f, Habib Haguiga, MD g, Sonia Khedher, MD h, Hamdi Boubaker, MD a, Kaouthar Beltaief, MD a, Mohamed Habib Grissa, MD a, Mohamed Naceur Trimech, MD a, Wiem Kerkeni, MD c, Nawfel Chebili, MD f, Imen Halila, MD c, Imen Rejeb, MD e, Riadh Boukef, MD a, Noureddine Rekik, MD e, Bechir Bouhaja, MD d, Mondher Letaief, MD b, Semir Nouira, MD a, ⁎
a Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia 
b Department of Preventive Epidemiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia 
c Emergency Department, Tahar Sfar University Hospital, Mahdia, Tunisia 
d Emergency Department, Ben Arous Hospital, Ben Arous, Tunisia 
e Emergency Department, Habib Bourguiba University Hospital, Sfax, Tunisia 
f Emergency Department, Sahloul University Hospital, Sousse, Tunisia 
g Intensive Care Unit and Emergency Department, Tozeur Hospital, Tozeur, Tunisia 
h Emergency Department, Sidi Bouzid Hospital, Sidi Bouzid, Tunisia 

Address for correspondence: Semir Nouira, MD

Résumé

Study objective

The New Orleans Criteria and the Canadian CT Head Rule have been developed to decrease the number of normal computed tomography (CT) results in mild head injury. We compare the performance of both decision rules for indentifying patients with intracranial traumatic lesions and those who require an urgent neurosurgical intervention after mild head injury.

Methods

This was an observational cohort study performed between 2008 and 2011 on patients with mild head injury who were aged 10 years or older. We collected prospectively clinical head CT scan findings and outcome. Primary outcome was need for neurosurgical intervention, defined as either death or craniotomy, or the need of intubation within 15 days of the traumatic event. Secondary outcome was the presence of traumatic lesions on head CT scan. New Orleans Criteria and Canadian CT Head Rule decision rules were compared by using sensitivity specifications and positive and negative predictive value.

Results

We enrolled 1,582 patients. Neurosurgical intervention was performed in 34 patients (2.1%) and positive CT findings were demonstrated in 218 patients (13.8%). Sensitivity and specificity for need for neurosurgical intervention were 100% (95% confidence interval [CI] 90% to 100%) and 60% (95% CI 44% to 76%) for the Canadian CT Head Rule and 82% (95% CI 69% to 95%) and 26% (95% CI 24% to 28%) for the New Orleans Criteria. Negative predictive values for the abovementioned clinical decision rules were 100% and 99% and positive values were 5% and 2%, respectively, for the Canadian CT Head Rule and New Orleans Criteria. Sensitivity and specificity for clinical significant head CT findings were 95% (95% CI 92% to 98%) and 65% (95% CI 62% to 68%) for the Canadian CT Head Rule and 86% (95% CI 81% to 91%) and 28% (95% CI 26% to 30%) for the New Orleans Criteria. A similar trend of results was found in the subgroup of patients with a Glasgow Coma Scale score of 15.

Conclusion

For patients with mild head injury, the Canadian CT Head Rule had higher sensitivity than the New Orleans Criteria, with higher negative predictive value. The question of whether the use of the Canadian CT Head Rule would have a greater influence on head CT scan reduction requires confirmation in real clinical practice.

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Plan


 A M3Q6SV8 survey is available with each research article published on the Web at www.annemergmed.com.
 A podcast for this article is available at www.annemergmed.com.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This research was supported by a grant from the Tunisian State Department of Research.
 Please see page 522 for the Editor's Capsule Summary of this article.
 Supervising editor: Judd E. Hollander, MD
 Author contributions: BB and SN conceived the study and designed the trial. SM, MM, RB, NR, and SN supervised the conduct of the trial and data collection. SS, HK, HH, SK, KB, MHG, MNT, WK, NC, IH, and IR undertook recruitment of participating centers and patients and managed the data, including quality control. ML and SN provided statistical advice on study design and analyzed the data. ML chaired the data oversight committee. SN drafted the article, and all authors contributed substantially to its revision. SN takes responsibility for the paper as a whole.
 Publication date: Available online August 22, 2012.


© 2012  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 61 - N° 5

P. 521-527 - mai 2013 Retour au numéro
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