基于多中心连续病例系列的轻微头部损伤患者 CHIP（头部损伤患者 CT）决策规则更新。

Update of the CHIP (CT in Head Injury Patients) decision rule for patients with minor head injury based on a multicenter consecutive case series.

机构信息

Department of Emergency Medicine, Haaglanden Medical Centre, PO Box 432, 2501 CK The Hague, the Netherlands; Department of Emergency Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Department of Public Health, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

出版信息

Injury. 2022 Sep;53(9):2979-2987. doi: 10.1016/j.injury.2022.07.001. Epub 2022 Jul 2.

DOI:10.1016/j.injury.2022.07.001

PMID:35831208

Abstract

OBJECTIVE

To update the existing CHIP (CT in Head Injury Patients) decision rule for detection of (intra)cranial findings in adult patients following minor head injury (MHI).

METHODS

The study is a prospective multicenter cohort study in the Netherlands. Consecutive MHI patients of 16 years and older were included. Primary outcome was any (intra)cranial traumatic finding on computed tomography (CT). Secondary outcomes were any potential neurosurgical lesion and neurosurgical intervention. The CHIP model was validated and subsequently updated and revised. Diagnostic performance was assessed by calculating the c-statistic.

RESULTS

Among 4557 included patients 3742 received a CT (82%). In 383 patients (8.4%) a traumatic finding was present on CT. A potential neurosurgical lesion was found in 73 patients (1.6%) with 26 (0.6%) patients that actually had neurosurgery or died as a result of traumatic brain injury. The original CHIP underestimated the risk of traumatic (intra)cranial findings in low-predicted-risk groups, while in high-predicted-risk groups the risk was overestimated. The c-statistic of the original CHIP model was 0.72 (95% CI 0.69-0.74) and it would have missed two potential neurosurgical lesions and one patient that underwent neurosurgery. The updated model performed similar to the original model regarding traumatic (intra)cranial findings (c-statistic 0.77 95% CI 0.74-0.79, after crossvalidation c-statistic 0.73). The updated CHIP had the same CT rate as the original CHIP (75%) and a similar sensitivity (92 versus 93%) and specificity (both 27%) for any traumatic (intra)cranial finding. However, the updated CHIP would not have missed any (potential) neurosurgical lesions and had a higher sensitivity for (potential) neurosurgical lesions or death as a result of traumatic brain injury (100% versus 96%).

CONCLUSIONS

Use of the updated CHIP decision rule is a good alternative to current decision rules for patients with MHI. In contrast to the original CHIP the update identified all patients with (potential) neurosurgical lesions without increasing CT rate.

摘要

目的

更新现有的 CHIP（颅脑损伤患者 CT 检查）决策规则，以检测成年患者轻微头部损伤（MHI）后的颅内（内）发现。

方法

本研究是荷兰的一项前瞻性多中心队列研究。连续纳入 16 岁及以上的 MHI 患者。主要结局为 CT 上任何（颅内）创伤性发现。次要结局为任何潜在的神经外科病变和神经外科干预。验证 CHIP 模型，然后对其进行更新和修订。通过计算 c 统计量评估诊断性能。

结果

在纳入的 4557 例患者中，3742 例行 CT（82%）。383 例（8.4%）患者 CT 上存在创伤性发现。73 例（1.6%）患者存在潜在的神经外科病变，其中 26 例（0.6%）患者因创伤性脑损伤接受神经外科手术或死亡。原始 CHIP 低估了低预测风险组的创伤性（颅内）发现风险，而高估了高预测风险组的风险。原始 CHIP 模型的 c 统计量为 0.72（95%CI 0.69-0.74），会漏诊 2 例潜在的神经外科病变和 1 例接受神经外科手术的患者。更新后的模型在颅脑创伤（颅内）发现方面与原始模型相似（c 统计量 0.77，95%CI 0.74-0.79，交叉验证后 c 统计量 0.73）。更新后的 CHIP 与原始 CHIP 的 CT 率相同（75%），对任何创伤性（颅内）发现的敏感性（92%对 93%）和特异性（均为 27%）相似。然而，更新后的 CHIP 不会漏诊任何（潜在）神经外科病变，并且对创伤性脑损伤导致的（潜在）神经外科病变或死亡的敏感性更高（100%对 96%）。