Sakkas Andreas, Weiß Christel, Wilde Frank, Ebeling Marcel, Scheurer Mario, Thiele Oliver Christian, Mischkowski Robert Andreas, Pietzka Sebastian
Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany.
Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany.
Diagnostics (Basel). 2023 May 23;13(11):1826. doi: 10.3390/diagnostics13111826.
The primary aim was to evaluate the compliance of cranial CT indication with the national guideline-based decision rules in patients after mTBI. The secondary aim was to determine the incidence of CT pathologies among justified and unjustified CT scans and to investigate the diagnostic value of these decision rules. This is a retrospective, single-center study on 1837 patients (mean age = 70.7 years) referred to a clinic of oral and maxillofacial surgery following mTBI over a five-year period. The current national clinical decision rules and recommendations for mTBI were retrospectively applied to calculate the incidence of unjustified CT imaging. The intracranial pathologies among the justified and unjustified CT scans were presented using descriptive statistical analysis. The performance of the decision rules was ascertained by calculating the sensitivity, specificity, and predictive values. A total of 123 intracerebral lesions were radiologically detected in 102 (5.5%) of the study patients. Most (62.1%) of the CT scans strictly complied with the guideline recommendations, and 37.8% were not justified and likely avoidable. A significantly higher incidence of intracranial pathology was observed in patients with justified CT scans compared with patients with unjustified CT scans (7.9% vs. 2.5%, < 0.0001). Patients with loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of cranial fractures presented pathologic CT findings more frequently ( < 0.05). The decision rules identified CT pathologies with 92.28% sensitivity and 39.08% specificity. To conclude, compliance with the national decision rules for mTBI was low, and more than a third of the CT scans performed were identified as "likely avoidable". A higher incidence of pathologic CT findings was detected in patients with justified cranial CT imaging. The investigated decision rules showed a high sensitivity but low specificity for predicting CT pathologies.
主要目的是评估颅脑CT检查指征在轻度创伤性脑损伤（mTBI）患者中是否符合基于国家指南的决策规则。次要目的是确定合理与不合理CT扫描中CT病理改变的发生率，并研究这些决策规则的诊断价值。这是一项回顾性单中心研究，研究对象为1837例患者（平均年龄 = 70.7岁），这些患者在五年期间因mTBI被转诊至口腔颌面外科诊所。回顾性应用当前国家关于mTBI的临床决策规则和建议来计算不合理CT成像的发生率。使用描述性统计分析展示合理与不合理CT扫描中的颅内病理改变。通过计算敏感性、特异性和预测值来确定决策规则的性能。研究患者中共有102例（5.5%）经影像学检查发现123个脑内病变。大多数（62.1%）CT扫描严格符合指南建议，37.8%不合理且可能可避免。与不合理CT扫描的患者相比，合理CT扫描的患者颅内病理改变的发生率显著更高（7.9% 对 2.5%，< 0.0001）。有意识丧失、失忆、癫痫发作、头痛、嗜睡、头晕、恶心和颅骨骨折临床体征的患者出现病理性CT表现的频率更高（< 0.05）。决策规则识别CT病理改变的敏感性为92.28%，特异性为39.08%。总之，mTBI患者对国家决策规则的依从性较低，超过三分之一的CT扫描被判定为“可能可避免”。在进行了合理颅脑CT成像的患者中检测到更高的病理性CT表现发生率。所研究的决策规则在预测CT病理改变方面显示出高敏感性但低特异性。
