| Title | Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. | | Author(s) | Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV, Zucker MI, NEXUS II Investigators | | Institution | UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, CA 90024, USA. wmower@ucla.edu | | Source | J Trauma 2005 Oct; 59(4):954-9. | | MeSH | Adult
Child
Craniocerebral Trauma
Decision Trees
Emergency Service, Hospital
Female
Glasgow Coma Scale
Humans
Intracranial Hemorrhage, Traumatic
Male
Middle Aged
Multicenter Studies
Neurologic Examination
Practice Guidelines
Predictive Value of Tests
Research Support, N.I.H., Extramural
Tomography, X-Ray Computed
Wounds, Nonpenetrating
| | Abstract | BACKGROUND: Computed tomographic (CT) head scanning of blunt trauma patients is expensive, delays care, and necessitates radiation exposure, while detecting intracranial injuries in a minority of patients. Clinical characteristics may be able reliably identify patients who do not have intracranial injuries and consequently, do no require imaging.
METHODS: Physicians assessed blunt trauma patients undergoing imaging for the presence or absence of specific criteria. Recursive partitioning was used to identify criteria that predict intracranial injuries with high sensitivity.
RESULTS: Intracranial injuries were found in 917 of 13,728 enrolled patients (6.7%). Injuries were rare among patients under age 65 who had no evidence of skull fracture, scalp hematoma, neurologic deficit, abnormal alertness, abnormal behavior, coagulopathy, or persistent vomiting. These characteristics would have identified 901 injury cases (sensitivity 98.3% [CI: 97.2-99.0]), while classifying 1,752 patients (12.8%) as "low risk."
CONCLUSIONS: Clinical characteristics can reliably identify patients who are unlikely to have intracranial injuries and who do not require CT imaging. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 16374287 |
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