Harnan Sue E, Pickering Alastair, Pandor Abdullah, Goodacre Steve W
School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK.
J Trauma. 2011 Jul;71(1):245-51. doi: 10.1097/TA.0b013e31820d090f.
There are many clinical decision rules for adults with minor head injury, but it is unclear how they compare in terms of diagnostic accuracy. This study aimed to systematically identify clinical decision rules for adults with minor head injury and compare the estimated diagnostic accuracies for any intracranial injury and injury requiring neurosurgical intervention.
Several electronic bibliographic databases covering biomedical, scientific, and gray literature were searched from inception to March 2010. At least two independent reviewers determined the eligibility of cohort studies that described a clinical decision rule to identify adults with minor head injury (Glasgow Coma Scale score, 13-15) at risk of intracranial injury or injury requiring neurosurgical intervention.
Twenty-two relevant studies were identified. Differences existed in patient selection, outcome definition, and reference standards used. Nine rules stratified patients into high- and moderate-risk categories (to identify neurosurgical or nonsurgical intracranial lesions). The Canadian Computed Tomography Head Rule (CCHR) high-risk criteria have sensitivity of 99% to 100% with specificity of 48% to 77% for injury requiring neurosurgical intervention. Other rules such as New Orleans criteria, National Emergency X-Radiography Utilization Study II, Neurotraumatology Committee of the World Federation of Neurosurgical Societies, Scandinavian, and Scottish Intercollegiate Guidelines Network produce similar sensitivities for injury requiring neurosurgical intervention but with lower and more variable specificity values.
The most widely researched decision rule is the CCHR, which has consistently shown high sensitivity for identifying injury requiring neurosurgical intervention with an acceptable specificity to allow considered use of cranial computed tomography. No other decision rule has been as widely validated or demonstrated as acceptable results, but its exclusion criteria make it difficult to apply universally.
针对轻度颅脑损伤的成年人有许多临床决策规则，但它们在诊断准确性方面的比较尚不清楚。本研究旨在系统地识别针对轻度颅脑损伤成年人的临床决策规则，并比较对任何颅内损伤和需要神经外科干预的损伤的估计诊断准确性。
检索了几个涵盖生物医学、科学和灰色文献的电子书目数据库，检索时间从建库至2010年3月。至少两名独立评审员确定队列研究的合格性，这些研究描述了用于识别有颅内损伤或需要神经外科干预风险的轻度颅脑损伤成年人（格拉斯哥昏迷量表评分13 - 15分）的临床决策规则。
共识别出22项相关研究。在患者选择、结局定义和使用的参考标准方面存在差异。九条规则将患者分为高风险和中度风险类别（以识别神经外科或非神经外科颅内病变）。加拿大头部计算机断层扫描规则（CCHR）的高风险标准对于需要神经外科干预的损伤，敏感性为99%至100%，特异性为48%至77%。其他规则，如新奥尔良标准、国家急诊X线摄影利用研究II、世界神经外科协会联合会神经创伤学委员会、斯堪的纳维亚和苏格兰校际指南网络，对于需要神经外科干预的损伤产生类似的敏感性，但特异性值较低且更具变异性。
研究最广泛的决策规则是CCHR，它一直显示出对识别需要神经外科干预的损伤具有高敏感性，且特异性可接受，以便考虑使用头颅计算机断层扫描。没有其他决策规则得到如此广泛的验证或显示出可接受的结果，但其排除标准使其难以普遍应用。
