Utility of the canadian ct head rule for patients with mtbi for the prediction of patient tomographic findings attended in hosgenaes

Utility of the canadian ct head rule for patients with mtbi for the prediction of patient tomographic findings attended in hosgenaes

Author: 
María de la Paz Zermeño Alfaro, Claudia Viviana Baena Jiménez, Carlos Jesús Lara Hernández, Pablo Isaías Noh Mendieta and Luis Alberto Bonilla Arcaute
Abstract: 

Introduction: Cranioencephalic trauma is generally defined according to the World Health Organization (WHO) as any physical injury, or functional deterioration of the cranial content secondary to a sudden exchange of mechanical energy and includes mild Traumatic Brain Injury(mTBI) with a score between 15 and 13 on the Glasgow coma scale. It is estimated that 80% of patients with traumatic brain injury who enter the emergency room have a slight risk. The initial clinical approach is the fundamental basis for diagnostic and therapeutic decisions that lead to the adequate use of tools such as skull tomography. With the use of the Candian CT Head Rule (CCHR) in patients with mTIB, the first contact physician may prioritize the need for a neurosurgical approach, as well as simple skull tomography, which inherently implies adequate use of resources and avoids risk of exposure to unnecessary ionizing radiation.
Objective: To determine the correlation of the presence of tomographic findings in patients with m TBI and the risk factors explored in the implementation of the CCHR protocol, attended at the Naval General Hospital of High Specialty (HOSGENAES).
Material and Methods: An observational, transversal, analytical, prospective study was carried out to collect patients with mTBI who were admitted to the Emergency Department of the High Specialty Naval General Hospital and the initial clinical assessment was applied using Canadian CT Head Rule and subsequent imaging evaluation in a period from May 2016 to August 2017.
Results: By correlation with Kendall's Tau-b, the degree of relationship between the variables included in the CCHR and the tomographic findings was obtained, being moderate (0.2441) for Glasgow, suspicion of skull fracture (0.2758), of the skull base (0.4387). and risk mechanism (0.2222), low relation with the presence of age over 65 years (0.1824), and with a very low relation vomiting (-0.0362) and presence of amnesia (-0.0322). The linearity between the number of factors and the findings increases as the number of positive items increases, with a high ratio of 0.5521 and a P value of <0.001.
Conclusions: The sensitivity and positive predictive value of the Canadian CT Head Rule demonstrated that it captures 96.67% of patients with clinical relevance and lesions observed with computed tomography. It maintains a high specificity of 90% in terms of applicability, has a high percentage of exclusivity in the identification of healthy patients.

 

Paper No: 
1608