Predicting Clinically Significant Brain Injuries Following Mild TBI: A Comparative Study of Canadian CT Head Rule and New Orleans Criteria at a National Trauma Centre.
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Keywords
Nigeria., Traumatic Brain Injury, Computed Tomography, Canadian CT head rule, New Orleans Criteria, Mild TBI, Clinical Decison Rules, Predictive values
Abstract
Background: Mild traumatic brain injury (mTBI) is one of the most common injuries treated at any trauma centre. Whereas the general use of CT for all patients with mTBI is inefficient and wasteful, the omission of a clinically important brain injury is not desirable. Several guidelines have been developed to assist physicians in determining who actually needs a head CT. For this reason, the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) were compared in this study on their efficacy in predicting surgically significant brain injuries and the need for neurosurgical intervention.
Methodology: The research was a prospective cross-sectional study at a level 1 trauma centre that received ethical approval from the Hospital. Consenting adult patients who presented with mild TBI within 24 hours were recruited. They were assessed with the NOC and CCHR, whose decisions were compared with each other and with CT head findings.
Results: A total of 103 patients were successfully enrolled, males were 91 and females were 12, with a mean age of 32.48±12.27 years old. The NOC guideline had a sensitivity (88.6%), specificity (21.4%), positive predictive value (47.0%) and negative predictive value (70.6%) of clinically significant brain injury; while CCHR guideline showed sensitivity (86.4%), specificity (30.4%), positive predictive value (49.4%) and negative predictive value (73.9%) of clinically significant brain injury (table 3), however, statistically were not significantly different with P-value of 0.39. Similarly, there was no statistically significant difference between the two guidelines for the need for neurosurgical intervention, as the P-value was 0.48.
Conclusion: Following the findings, this study suggests that either NOC or CCHR is safe to be used for ordering a head CT for patients with mild TBI.
References
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Selekeowei Peter Kespi Kpuduwei, Department of Surgery, Federal Medical Centre, Yenagoa, Bayelsa State
Dr S. Kpuduwei is a Consultant Neurosurgeon at the Federal Medical Centre, Yenagoa and Adjunct Lecturer at the Bayelsa Medical University, Yenagoa.
Ayodeji Salman Yusuf, Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Abuja
Dr A.S. Yusuf is an Associate Professor of the University of Abuja and Consultant Neurosurgeon/Head of Department of Neurosurgery at the National Hospital Abuja.
Nasiru Jinjiri Ismail, Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Prof N.J. Ismail is a Professor of Neurosurgery at the Usmanu Danfodiyo University and Consultant at the at its teaching hospital and visiting consultant at the Department of Neurosurgery, National Hospital Abuja.