Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

Clinical article

Harald Wolf M.D.1, Wolfgang Machold M.D.1, Sophie Frantal M.S.2, Mathias Kecht M.D.1, Gholam Pajenda M.D.1, Johannes Leitgeb M.D.1, Harald Widhalm M.D.1, Stefan Hajdu M.D., Ph.D.1, and Kambiz Sarahrudi M.D., Ph.D.1
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  • 1 Departments of Trauma Surgery and
  • | 2 Medical Statistics, Medical University of Vienna, Austria
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Object

This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR).

Methods

This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma.

Results

Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%.

Conclusions

The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

Abbreviations used in this paper:

AUC = area under the curve; CCHR = Canadian CT Head Rule; GCS = Glasgow Coma Scale; ICU = intensive care unit; LASSO = least absolute shrinkage and selection operator; TBI = traumatic brain injury.

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