دورية أكاديمية
أعرض في EDS

The Florida Geriatric Head Trauma CT Clinical Decision Rule.

التفاصيل البيبلوغرافية
العنوان: The Florida Geriatric Head Trauma CT Clinical Decision Rule.
المؤلفون: Shih RD; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Depatment of Emergency Medicine, Delray Medical Center, Delray Beach, Florida, USA., Alter SM; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Depatment of Emergency Medicine, Delray Medical Center, Delray Beach, Florida, USA.; Depatment of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida, USA., Wells M; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA., Solano JJ; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Depatment of Emergency Medicine, Delray Medical Center, Delray Beach, Florida, USA.; Depatment of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida, USA., Engstrom G; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA., Clayton LM; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Depatment of Emergency Medicine, Delray Medical Center, Delray Beach, Florida, USA.; Depatment of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida, USA., Hughes PG; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Depatment of Emergency Medicine, Delray Medical Center, Delray Beach, Florida, USA.; Depatment of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida, USA., Goldstein L; Department of Emergency Medicine, Memorial Healthcare System, Hollywood, Florida, USA., Lottenberg L; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.; Department of Surgery, St. Mary's Medical Center, West Palm Beach, Florida, USA., Ouslander JG; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
المصدر: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Sep; Vol. 72 (9), pp. 2738-2751. Date of Electronic Publication: 2024 Jul 03.
نوع المنشور: Journal Article; Validation Study
اللغة: English
بيانات الدورية: Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
أسماء مطبوعة: Publication: Malden, MA : Blackwell Science
Original Publication: New York [etc.]
مواضيع طبية MeSH: Tomography, X-Ray Computed* , Clinical Decision Rules* , Emergency Service, Hospital* , Craniocerebral Trauma*/diagnostic imaging, Humans ; Aged ; Female ; Male ; Aged, 80 and over ; Florida ; Head Injuries, Closed/diagnostic imaging ; Glasgow Coma Scale
مستخلص: Background: Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults.
Methods: We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split-sample derivation cohort and then tested in an independent validation cohort.
Results: Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) <15 (+20 points), GCS <14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total ≥25 had a sensitivity and specificity of 100.0% (95% CI: 96.0-100) and 12.3% (95% CI: 10.9-13.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention.
Conclusions: The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice.
(© 2024 The American Geriatrics Society.)
References: Peterson AB, Zhou H, Thomas KE. Disparities in traumatic brain injury‐related deaths‐United States, 2020. J Saf Res. 2022;83:419‐426.
Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ≥65 years—United States, 2014. Morb Mortal Wkly Rep. 2016;65:993‐998.
Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta (GA); 2010.
Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66:1‐16.
DeAngelis J, Lou V, Li T, et al. Head CT for minor head injury presenting to the emergency Department in the era of choosing wisely. West J Emerg Med. 2017;18:821‐829.
Smits M, Dippel DW, de Haan GG, et al. External validation of the Canadian CT head rule and the New Orleans criteria for CT scanning in patients with minor head injury. JAMA. 2005;294:1519‐1525.
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PMC. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343:100‐105.
Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357:1391‐1406.
Stiell IG, Clement CM, Rowe BH, et al. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury. JAMA. 2005;294:1511‐1518.
Mower WR, Hoffman JR, Herbert M, et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59:954‐959.
Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically‐important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374:1160‐1170.
ClinicalTrials.gov Protocol Registration and Results System. Geriatric Head Trauma Short Term Outcomes Project (GREAT‐STOP). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00094CT&selectaction=Edit&uid=U0004P24&ts=2&cx=‐okdt7i. Last accessed November 15.2023.
Wintermark M, Li Y, Ding VY, et al. Neuroimaging radiological interpretation system for acute traumatic brain injury. J Neurotrauma. 2018;35:2665‐2672.
Brinjikji W, Kallmes D, Cloft H. Rising utilization of CT in adult fall patients. AJR. 2015;204:558‐562.
Expert Panel on Neurological Imaging, Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® head trauma: 2021 update. J Am Coll Radiol. 2021;18:S13‐S36.
Fawcett R, McCoubrie P. Pitfalls in imaging the frail elderly. Br J Radiol. 2015;88:20140699.
Beinfeld MT, Gazelle GS. Diagnostic imaging costs: are they driving up the costs of hospital care? Radiology. 2005;235:934‐939.
Rathlev NK, Medzon R, Lowery D, et al. Intracranial pathology in elders with blunt head trauma. Acad Emerg Med. 2006;13:302‐307.
de Wit K, Parpia S, Varner C, et al. Clinical predictors of intracranial bleeding in older adults who have fallen: a cohort study. J Am Geriatr Soc. 2020;68(5):970‐976.
de Wit K, Mercuri M, Clayton N, et al. Derivation of the falls decision rule to exclude intracranial bleeding without head CT in older adults who have fallen. CMAJ. 2023;195:E1614‐E1621.
Marin JR, Mills AM. Developing a research agenda to optimize diagnostic imaging in the emergency department: an executive summary of the 2015 academic emergency medicine consensus conference. Pediatr Emerg Care. 2015;31:876‐882.
Gunn ML, Marin JR, Mills AM, et al. A report on the academic emergency medicine 2015 consensus conference “diagnostic imaging in the emergency department: a research agenda to optimize utilization”. Emerg Radiol. 2016;23:383‐396.
Mower WR, Akie TE, Morizadeh N, et al. Blunt head injury in the elderly: analysis of the NEXUS II injury cohort. Ann Emerg Med. 2024;83(5):457‐466.
Valente JH, Anderson JD, Paolo WF, et al. Clinical policy: critical issues in the Management of Adult Patients Presenting to the emergency department with mild traumatic brain injury: approved by ACEP Board of directors, February 1, 2023 clinical policy endorsed by the emergency nurses association (April 5, 2023). Ann Emerg Med. 2023;81:e63‐e105.
Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med. 2015;162:55‐63.
Riley RD, Ensor J, Snell KIE, et al. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368:m441.
Paul AB, Oklu R, Saini S, Prabhakar AM. How much is that head CT? Price transparency and variability in radiology. J Am Coll Radiol. 2015;12:453‐457.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277‐2284.
Hendee WR, Becker GJ, Borgstede JP, et al. Addressing overutilization in medical imaging. Radiology. 2010;257:240‐245.
Davey K, Saul T, Russel G, Wassermann J, Quaas J. Application of the Canadian computed tomography head rule to patients with minimal head injury. Ann Emerg Med. 2018;72:342‐350.
LeBlanc J, de Guise E, Gosselin N, et al. Comparison of functional outcome following acute care in young, middle‐aged and elderly patients with traumatic brain injury. Brain Inj. 2006;20:779‐790.
Stovell MG, Jenkinson MD. Neurosurgery in octogenarians. Br J Neurosurg. 2014;28:611‐615.
Capron GK, Voights MB, Moore HR 3rd, et al. Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: application of the brain injury guidelines to patients transferred to a level 1 trauma center. Am J Surg. 2017;214:1182‐1185.
Carpenter CR, Arendts G, Hullick C, Nagaraj G, Cooper Z, Burkett E. Major trauma in the older patient: evolving trauma care beyond management of bumps and bruises. Emerg Med Australas. 2017;29:450‐455.
Yun BJ, White BA, Benjamin Harvey H, et al. Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a level 1 trauma center. Am J Emerg Med. 2017;35:1281‐1284.
Hogan TM, Richmond NL, Carpenter CR, et al. Shared decision making to improve the emergency care of older adults: a research agenda. Acad Emerg Med. 2016;23:1386‐1393.
Sahgal S, Yande A, Thompson BB, et al. Surrogate satisfaction with decision making after intracerebral hemorrhage. Neurocrit Care. 2021;34:193‐200.
Fournier N, Gariepy C, Prévost JF, et al. Adapting the Canadian CT head rule age criteria for mild traumatic brain injury. Emerg Med J. 2019;36:617‐619.
Sartin R, Kim C, Dissanaike S. Discussion of: “is routine head CT indicated in awake stable older patients after a ground level fall?”. Am J Surg. 2017;214:1055‐1058.
Jeanmonod R, Asher S, Roper J, et al. History and physical exam predictors of intracranial injury in the elderly fall patient: a prospective multicenter study. Am J Emerg Med. 2019;37:1470‐1475.
Pages PJ, Boncoeur‐Martel MP, Dalmay F, et al. Relevance of emergency head CT scan for fall in the elderly person. J Neuroradiol. 2020;47:54‐58.
Nagaraj G, Burkett E, Hullick C, Carpenter CR, Arendts G. Is delirium the medical emergency we know least about? Emerg Med Australas. 2016;28:456‐458.
Nowroozpoor A, Dussetschleger J, Perry W, et al. Detecting cognitive impairment and dementia in the emergency department: a scoping review. J Am Med Dir Assoc. 2022;23:1314.e31‐1314.e88.
Lee S, Chen H, Hibino S, et al. Can we improve delirium prevention and treatment in the emergency department? A systematic review. J Am Geriatr Soc. 2022;70(6):1838‐1849.
Carpenter CR, Leggett J, Bellolio F, et al. Emergency department communication in persons living with dementia and care partners: a scoping review. J Am Med Dir Assoc. 2022;23:1313.e15‐1313.e46.
Cohen DB, Rinker C, Wilberger JE. Traumatic brain injury in anticoagulated patients. J Trauma. 2006;60:553‐557.
Smits M, Diederik W, Dippel W, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med. 2007;146:397‐405.
Menditto VG, Lucci M, Polonara S, Pomponio G, Gabrielli A. Management of minor head injury in patients receiving oral antico‐ agulant therapy: a prospective study of a 24‐hour observation proto‐ col. Ann Emerg Med. 2012;59:451‐455.
Scotti P, Séguin C, Lo BWY, et al. Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes. J Neurosurg. 2019;133(2):486‐495.
Laic RAG, Verhamme P, Vander Sloten J, Depreitere B. Long‐term outcomes after traumatic brain injury in elderly patients on antithrombotic therapy. Acta Neurochir. 2023;165:1297‐1307.
Nishijima DK, Offerman SR, Ballard DW, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012;59:460‐468.
Hamden K, Agresti D, Jeanmonod R, Woods D, Reiter M, Jeanmonod D. Characteristics of elderly fall patients with baseline mental status: high‐risk features for intracranial injury. Am J Emerg Med. 2014;32:890‐894.
Chenoweth JA, Gaona SD, Faul M, Holmes JF, Nishijima DK, for the Sacramento County Prehospital Research Consortium. Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma. JAMA Surg. 2018;153:570‐575.
Mack L, Chan S, Silva J, et al. The use of head computed tomography in elderly patients sustaining minor head trauma. J Emerg Med. 2003;24:157‐162.
Allen J, Ravichandiran K, McLaughlin TL, et al. The Utility of Head CT Scans in Geriatric Patients with Hip Fractures Following a Low Energy Injury Mechanism: A Retrospective Review.
McCabe AM, Kuppermann N. Generation of evidence and translation into practice: lessons learned and future directions. Acad Emerg Med. 2015;22:1372‐1379.
Wong AC, Kowalenko T, Roahen‐Harrison S, Smith B, Maio RF, Stanley RM. A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma. Pediatr Emerg Care. 2011;27:182‐185.
Lindor RA, Boie ET, Campbell RL, Hess EP, Sadosty AT. Failure to obtain computed tomography imaging in head trauma: a review of relevant case law. Acad Emerg Med. 2015;22:1493‐1498.
Melnick ER, Shafer K, Rodulfo N, et al. Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study. Acad Emerg Med. 2015;22:1474‐1483.
U.S. Census Bureau. American Community Survey. 2019 data, by Richard Shih; using data.census.gov; https://www.census.gov/en.html (March 15, 2024).
Assel M, Sjoberg DD, Vickers AJ. The brier score does not evaluate the clinical utility of diagnostic tests or prediction models. Diagn Progn Res. 2017;1:19.
معلومات مُعتمدة: RFA #2018-01 The Florida Medical Malpractice Joint Underwriting Association Grant for Safety of Health Care Services
فهرسة مساهمة: Keywords: CT scan; clinical decision rule; head trauma
تواريخ الأحداث: Date Created: 20240703 Date Completed: 20240902 Latest Revision: 20240902
رمز التحديث: 20240903
DOI: 10.1111/jgs.19057
PMID: 38959158
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-5415
DOI:10.1111/jgs.19057