High‐yield Selection Criteria for Cranial Computed Tomography after Acute Trauma
- 1 April 1995
- journal article
- Published by Wiley in Academic Emergency Medicine
- Vol. 2 (4), 248-253
- https://doi.org/10.1111/j.1553-2712.1995.tb03217.x
Abstract
To develop and prospectively evaluate criteria for selecting head-injured patients requiring cranial CT. A two-phased prospective observational study design was implemented at a university ED. Physicians completed a form with 51 variables for 540 patients in Phase I. Ten high-yield variables were identified and prospectively tested on 273 patients in Phase II. Prediction rule performance for identification of patients with abnormal CT scans was determined. The combined criteria had a sensitivity of 97% for CT-scan abnormalities in Phase I; sensitivity was 96% in Phase II. Negative predictive values were 97% and 94%, respectively. Prevalence of disease in Phase I was 17%; prevalence in Phase II was 16%. Had the Phase I criteria been implemented during Phase II, 43 of 273 patients (16%) would not have been scanned, including two patients with positive results who did not require operative intervention. Fifty-one clinical variables from head-injured patients were narrowed to ten of statistical significance and consistent interpretation for prospective evaluation. Patients with none of these criteria were found to be at low risk of having sustained significant head injury.Keywords
This publication has 10 references indexed in Scilit:
- A prospective study to identify high-yield criteria associated with acute intracranial computed tomography findings in head-injured patientsThe American Journal of Emergency Medicine, 1993
- Practical selection criteria for noncontrast cranial computed tomography in patients with head traumaAnnals of Emergency Medicine, 1993
- Inadequacy of Bedside Clinical Indicators in Identifying Significant Intracranial Injury in Trauma PatientsJournal Of Trauma-Injury Infection and Critical Care, 1992
- Is routine computed tomography scanning too expensive for mild head injury?Annals of Emergency Medicine, 1991
- The Use of CT Scanning to Triage Patients Requiring Admission Following Minimal Head InjuryJournal Of Trauma-Injury Infection and Critical Care, 1991
- The Value of Intubating and Paralyzing Patients with Suspected Head Injury in the Emergency DepartmentJournal Of Trauma-Injury Infection and Critical Care, 1991
- The Value of Computed Tomographic Scans in Patients with Low-Risk Head InjuriesNeurosurgery, 1990
- Skull X-Ray Examinations after Head TraumaNew England Journal of Medicine, 1987
- The Utility and Futility of Radiographic Skull Examination for TraumaNew England Journal of Medicine, 1971