The Florida Geriatric Head Trauma CT Clinical Decision Rule

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-03 DOI:10.1111/jgs.19057

Richard D. Shih MD, Scott M. Alter MD, Mike Wells MBBCh, PhD, Joshua J. Solano MD, Gabriella Engstrom PhD, RN, Lisa M. Clayton DO, Patrick G. Hughes DO, Lara Goldstein MBBCh, PhD, Lawrence Lottenberg MD, Joseph G. Ouslander MD

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

佛罗里达州老年头部创伤 CT 临床决策规则。

背景：目前已设计出几种临床决策规则来指导头部轻微损伤患者使用头部计算机断层扫描（CT），但没有一种规则在 65 岁或以上的患者中得到验证。我们的目标是为老年人制定并验证头部损伤临床决策规则：我们对现有的急诊科（ED）连续数据集进行了二次分析，该数据集包含年龄大于 65 岁的钝性头部外伤患者。主要的预测结果是明显的颅内损伤和 CT 神经外科干预需求。在模型开发和验证过程中还考虑了次要结果，即所有损伤和所有颅内损伤。使用多变量逻辑回归确定了预测变量，并在分离样本衍生队列中开发了临床决策规则模型，然后在独立验证队列中进行了测试：在 5776 名患者中，有 233 人（4.0%）有明显的颅内损伤，另有 104 人（1.8%）符合需要神经外科干预的 CT 标准。表现最好的模型是佛罗里达老年头部创伤 CT 临床决策规则，它根据几个临床变量分配分数。如果总分达到或超过 25 分，则需要进行 CT 扫描。其中的预测因素包括通过紧急医疗服务到达（+30 分）、格拉斯哥昏迷量表（GCS）结论：佛罗里达州老年头部创伤 CT 临床决策规则有可能减少老年人不必要的 CT 扫描，同时又不影响安全的急诊医学实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.