Bouida Wahid, Marghli Soudani, Souissi Sami, Ksibi Hichem, Methammem Mehdi, Haguiga Habib, Khedher Sonia, Boubaker Hamdi, Beltaief Kaouthar, Grissa Mohamed Habib, Trimech Mohamed Naceur, Kerkeni Wiem, Chebili Nawfel, Halila Imen, Rejeb Imen, Boukef Riadh, Rekik Noureddine, Bouhaja Bechir, Letaief Mondher, Nouira Semir
Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Ann Emerg Med. 2013 May;61(5):521-7. doi: 10.1016/j.annemergmed.2012.07.016. Epub 2012 Aug 22.
The New Orleans Criteria and the Canadian CT Head Rule have been developed to decrease the number of normal computed tomography (CT) results in mild head injury. We compare the performance of both decision rules for identifying patients with intracranial traumatic lesions and those who require an urgent neurosurgical intervention after mild head injury.
This was an observational cohort study performed between 2008 and 2011 on patients with mild head injury who were aged 10 years or older. We collected prospectively clinical head CT scan findings and outcome. Primary outcome was need for neurosurgical intervention, defined as either death or craniotomy, or the need of intubation within 15 days of the traumatic event. Secondary outcome was the presence of traumatic lesions on head CT scan. New Orleans Criteria and Canadian CT Head Rule decision rules were compared by using sensitivity specifications and positive and negative predictive value.
We enrolled 1,582 patients. Neurosurgical intervention was performed in 34 patients (2.1%) and positive CT findings were demonstrated in 218 patients (13.8%). Sensitivity and specificity for need for neurosurgical intervention were 100% (95% confidence interval [CI] 90% to 100%) and 60% (95% CI 44% to 76%) for the Canadian CT Head Rule and 82% (95% CI 69% to 95%) and 26% (95% CI 24% to 28%) for the New Orleans Criteria. Negative predictive values for the above-mentioned clinical decision rules were 100% and 99% and positive values were 5% and 2%, respectively, for the Canadian CT Head Rule and New Orleans Criteria. Sensitivity and specificity for clinical significant head CT findings were 95% (95% CI 92% to 98%) and 65% (95% CI 62% to 68%) for the Canadian CT Head Rule and 86% (95% CI 81% to 91%) and 28% (95% CI 26% to 30%) for the New Orleans Criteria. A similar trend of results was found in the subgroup of patients with a Glasgow Coma Scale score of 15.
For patients with mild head injury, the Canadian CT Head Rule had higher sensitivity than the New Orleans Criteria, with higher negative predictive value. The question of whether the use of the Canadian CT Head Rule would have a greater influence on head CT scan reduction requires confirmation in real clinical practice.
新奥尔良标准和加拿大头颅CT规则已被制定出来，以减少轻度头部损伤患者中计算机断层扫描（CT）结果正常的数量。我们比较了这两种决策规则在识别轻度头部损伤后有颅内创伤性病变的患者以及需要紧急神经外科干预的患者方面的性能。
这是一项在2008年至2011年期间对10岁及以上轻度头部损伤患者进行的观察性队列研究。我们前瞻性地收集了临床头部CT扫描结果和结局。主要结局是神经外科干预的必要性，定义为死亡、开颅手术或在创伤事件发生后15天内需要插管。次要结局是头部CT扫描上存在创伤性病变。通过使用敏感性指标以及阳性和阴性预测值来比较新奥尔良标准和加拿大头颅CT规则决策规则。
我们纳入了1582例患者。34例患者（2.1%）接受了神经外科干预，218例患者（13.8%）CT检查结果为阳性。加拿大头颅CT规则对于神经外科干预必要性的敏感性和特异性分别为100%（95%置信区间[CI]90%至100%）和60%（95%CI44%至76%），新奥尔良标准的敏感性和特异性分别为82%（95%CI69%至95%）和26%（95%CI24%至28%）。上述临床决策规则的阴性预测值，加拿大头颅CT规则和新奥尔良标准分别为100%和99%，阳性预测值分别为5%和2%。加拿大头颅CT规则对于具有临床意义的头部CT检查结果的敏感性和特异性分别为95%（95%CI92%至98%）和65%（95%CI62%至68%），新奥尔良标准的敏感性和特异性分别为86%（95%CI81%至91%）和28%（95%CI26%至30%）。在格拉斯哥昏迷量表评分为15分的患者亚组中也发现了类似的结果趋势。
对于轻度头部损伤患者，加拿大头颅CT规则比新奥尔良标准具有更高的敏感性，阴性预测值也更高。在实际临床实践中，加拿大头颅CT规则的使用是否会对减少头部CT扫描有更大影响这一问题需要得到证实。
