External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center.

20:34 EST 26th November 2014 | BioPortfolio

Summary of "External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center."


BACKGROUND:
Head CT scans are considered the imaging modality of choice to screen patients with head trauma for neurocranial injuries; however, widespread CT imaging is not recommended and much research has been conducted to establish objective clinical predictors of intracranial injury (ICI) in order to optimize the use of neuroimaging in children with minor head trauma.
OBJECTIVE:
To evaluate whether a strict application of the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR) and National Emergency X-Radiography Utilization Study II (NEXUS II) in pediatric patients with head trauma presenting to a non-trauma center (level II) could reduce the number of cranial CT scans performed without missing clinically significant ICI. MATERIALS AND
METHODS:
We conducted an IRB-approved retrospective analysis of pediatric patients with head trauma who received a cranial CT scan between Jan. 1, 2001, and Sept. 1, 2008, and identified which patients would have required a scan based on the criteria of the above listed decision instruments. We then determined the sensitivities, specificities and negative predictive values of these aids.
RESULTS:
In our cohort of 2,101 patients, 92 (4.4%) had positive head CT findings. The sensitivities for the NOC, CCHR and NEXUS II were 96.7% (95%CI 93.1-100), 65.2% (95%CI 55.5-74.9) and 78.3% (95%CI 69.9-86.7), respectively, and their negative predictive values were 98.7%, 97.6% and 97.2%, respectively. In contrast, the specificities for these aids were 11.2% (95%CI 9.8-12.6), 64.2% (95%CI 62.1-66.3) and 34.2% (95%CI 32.1-36.3), respectively. Therefore, in our population it would have been possible to scan at least 10.9% fewer patients.
CONCLUSIONS:
The number of cranial CT scans conducted in our pediatric cohort with head trauma would have been reduced had any of the three clinical decision aids been applied. Therefore, we recommend that further validation and adoption of pediatric head CT decision aids in non-trauma centers be considered to ultimately increase patient safety while reducing medical expense.

Affiliation

Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA.

Journal Details

This article was published in the following journal.

Name: Pediatric radiology
ISSN: 1432-1998
Pages:

Links

PubMed Articles [10815 Associated PubMed Articles listed on BioPortfolio]

Prediction of bacteremia in the emergency department: an external validation of a clinical decision rule.

The objective of this study was to validate a previously published clinical decision rule for predicting a positive blood culture in emergency department (ED) patients with suspected infection on the ...

Derivation and validation of a prediction rule for two year mortality in early diffuse cutaneous systemic sclerosis.

Objective: Systemic sclerosis (SSc) is associated with a reduction in life expectancy, but there are no validated prognostic models for short-term mortality. The objective of this study was to derive ...

The identification of human papillomavirus status specific biomarker in head and neck cancer.

Background. For improving the prognosis of head and neck cancer (HNC) patients, it could be necessary to identify biomarkers in homogeneous subgroups of HNC patients. Methods. We explored the necessit...

Did "zero tolerance for head contact" rule enforcement change the risk of game related concussions in youth ice hockey players?

Ice hockey is a popular winter sport in Canada. Concussion accounts for the greatest proportion of all injuries in youth ice hockey. Research has informed policy change enforcing the no head contact r...

Imaging appropriateness criteria: Why Canadian family physicians should care.

Clinical Trials [2234 Associated Clinical Trials listed on BioPortfolio]

Canadian Computed Tomography (CT) Head Rule Study

Each year, Canadian emergency department physicians treat 600,000 patients with head injury. Many of these are adults with "minor head injury", i.e. loss of consciousness or amnesia and a ...

Validation of the San Francisco Syncope Rule

This study was designed to validate the "San Francisco Syncope Rule". This set of rules was derived by Quinn et. al. to help guide the treatment of patients evaluated in the Emergency Dep...

Clinical Decision Rule Validation Study to Predict Low Recurrent Risk in Patients With Unprovoked Venous Thromboembolis

The main objective of this study is to verify whether a new clinical decision rule identifying patients diagnosed with unprovoked blood clots who have a low risk of recurrence can safely s...

Limited Compression Ultrasound by Emergency Physicians to Exclude Deep Vein Thrombosis

Deep vein thrombosis is a common condition seen in the Emergency Department. Standard of care for diagnosis of DVT includes a combination of a clinical pre-test probability rule known as ...

Assessing Patient Response to Therapeutic Exercise Based on Clinical Prediction Rule (CPR) for Spinal Manipulation

The purpose of this study is to determine whether patients who meet the criteria of the clinical prediction rule for spinal manipulation may respond more favorably to repeated exercises ac...

Medical and Biotech [MESH] Definitions

City in Orleans Parish (county), largest city in state of LOUISIANA. It is located between the Mississippi River and Lake Pontchartrain.

The condition characterized by uneven or irregular shape of the head often in parallelogram shape with a flat spot on the back or one side of the head. It can either result from the premature CRANIAL SUTURE closure (CRANIOSYNOSTOSIS) or from external forces (NONSYNOSTOTIC PLAGIOCEPHALY).

Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.

The two principal arteries supplying the structures of the head and neck. They ascend in the neck, one on each side, and at the level of the upper border of the thyroid cartilage, each divides into two branches, the external (CAROTID ARTERY, EXTERNAL) and internal (CAROTID ARTERY, INTERNAL) carotid arteries.

The outer part of the hearing system of the body. It includes the shell-like EAR AURICLE which collects sound, and the EXTERNAL EAR CANAL, the TYMPANIC MEMBRANE, and the EXTERNAL EAR CARTILAGES.

Search BioPortfolio:
Loading
Advertisement

Relevant Topics

Pediatrics
Latest News Clinical Trials Research Drugs Reports Corporate
Pediatrics is the general medicine of childhood. Because of the developmental processes (psychological and physical) of childhood, the involvement of parents, and the social management of conditions at home and at school, pediatrics is a specialty. With ...

Public Health
Latest News Clinical Trials Research Drugs Reports Corporate
Public health is the scientific, political and sociological approach by a society to maximise the health of the population through disease preventaion and mainenance of healthy life-styles. The mains areas of public health are epidemiology, biostatistics...

Radiology
Latest News Clinical Trials Research Drugs Reports Corporate
Radiology is the branch of medicine that studies imaging of the body; X-ray (basic, angiography, barium swallows), ultrasound, MRI, CT and PET. These imaging techniques can be used to diagnose, but also to treat a range of conditions, by allowing visuali...

Advertisement