Validation of the Scandinavian neurotrauma committee guidelines – A retrospective study in region Örebro county

Abstract

Introduction

Traumatic Brain Injury (TBI) is a global health concern and a leading cause of trauma-related death worldwide. Computed tomography (CT) scan is the gold standard for screening for intracranial bleeding following TBI. Most cases of TBI are mild, with negative CT scans. Different instruments and guidelines are employed to better predict which patients need a CT scan and to minimise unnecessary radiation exposure and save resources. One such instrument is the Scandinavian Neurotrauma Committee guidelines.

Research question

To validate and examine adherence to the Scandinavian Neurotrauma Committee guidelines in Region Örebro County.

Material and methods

We executed a retrospective study with review of patient records and data analysis. Descriptive and comparative statistics were used, along with binary logistic regression analysis to account for confounding factors.

Results

A total of 505 cases were reviewed. Sensitivity of the guidelines was measured at 95% with specificity at 29%. The positive and negative predictive values were 0.77 and 0.69, respectively. A total of 17 false negative cases were found. One case required surgery, during which a chronic subdural hematoma was identified. Adherence to guidelines was 56%, with the lack of analysis of S100B primarily accounting for non-adherence. A total of 54 CT scans were performed outside of guideline indications.

Discussion and conclusions

The guidelines can effectively predict which patients need a CT scan. Increased adherence could potentially decrease the number of CT scans, while inclusion of older age limit as an independent rule-in law for CT scans would increase patient safety.