Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Quebec, Canada.
Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada.
Emerg Med J. 2019 Oct;36(10):617-619. doi: 10.1136/emermed-2018-208153. Epub 2019 Jul 20.
With the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.
We conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardised. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75 and 80 years old.
104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% CI) of the CCHR were 100% (89.1 to 100) and 4.2% (0.9 to 11.7) for a modified criteria of 70 years old; 100% (89.1 to 100) and 13.9% (6.9 to 24.1) for 75 years old; and 90.6% (75.0 to 98.0) and 23.6% (14.4 to 35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n=10/41) among the individuals aged 65-74 without missing CIBI.
Adjusting the age criteria of the Canadian CT head rule to 75 years old could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.
随着人口老龄化，老年患者中轻度创伤性脑损伤（mTBI）的患病率正在上升，许多急诊医生对加拿大 CT 头部规则（CCHR）的年龄标准提出了质疑。我们修改了 CCHR 的年龄标准，以评估其预测能力。
我们对一家 1 级创伤中心急诊科在 2010 年至 2014 年间患有 65 岁及以上 mTBI 的所有 mTBI 患者进行了回顾性队列研究。主要结果是 CT 报告的临床重要性脑损伤（CIBI）。临床和影像学数据的收集是标准化的。进行单变量分析以测量 70、75 和 80 岁时不同年龄截止值的预测能力。
共纳入 104 例确诊 mTBI；CT 扫描发现 32 例（30.8%）CIBI。改良 70 岁年龄标准的 CCHR 灵敏度和特异性（95%CI）分别为 100%（89.1 至 100）和 4.2%（0.9 至 11.7）；75 岁为 100%（89.1 至 100）和 13.9%（6.9 至 24.1）；80 岁为 90.6%（75.0 至 98.0）和 23.6%（14.4 至 35.1）。此外，将年龄标准修改为 75 岁，可使 65-74 岁年龄组的 CT 减少 25%（n=10/41），而不会遗漏 CIBI。
调整加拿大 CT 头部规则的年龄标准至 75 岁可能是安全的，同时减少了辐射和急诊资源的使用。建议进行一项前瞻性研究以确认所提出的修改。
