Yogo Naoki, Toida Chiaki, Muguruma Takashi, Gakumazawa Masayasu, Shinohara Mafumi, Takeuchi Ichiro
Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan.
Department of Pediatrics, Division of Pediatric Emergency and Critical Care, Japanese Red Cross Kumamoto Hospital, 2-1-1 Ngamineminami, Higashi-ku, Kumamoto 861-8520, Japan.
J Clin Med. 2021 Nov 11;10(22):5248. doi: 10.3390/jcm10225248.
Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5-89.0%) and a specificity of 50.9% (95% CI: 48.9-52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67-0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66-0.77; 0.67, 95% CI: 0.61-0.74; and 0.69, 95% CI: 0.64-0.73, respectively; = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.
计算机断层扫描（CT）有助于确诊头部损伤。然而，对于判定头部受伤的儿科患者是否需要进行CT扫描，目前尚无标准的临床决策规则（CDR）。我们制定了一项CDR，并开展了一项回顾性队列研究，以评估其在识别具有临床重要性的创伤性脑损伤（ciTBI）儿童方面的诊断准确性。我们基于三项现有的CDR（CATCH、CHALICE和PECARN）选择预测指标。在2569名符合条件的患者中，645名（439名（68%）为男孩，中位年龄：5岁）纳入本研究。共有59名（9%）患者显示存在ciTBI，129名（20%）入院治疗。新的CDR包含六个CT异常结果的预测指标。其灵敏度为79.5%（95%置信区间（CI）：65.5 - 89.0%），特异度为50.9%（95% CI：48.9 - 52.3%）。受试者工作特征曲线下面积（0.72，95% CI：0.67 - 0.77）不低于CATCH、CHALICE和PECARN（分别为0.71，95% CI：0.66 - 0.77；0.67，95% CI：0.61 - 0.74；以及0.69，95% CI：0.64 - 0.73；P = 0.57）。与三项现有的CDR相比，新的CDR在诊断准确性方面在统计学上并不逊色。在临床应用之前，还需要进一步开展开发和验证研究。
