斯堪的纳维亚指南对儿童轻度和中度头部创伤的诊断准确性：一项前瞻性、实用性、验证性研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-02-13 DOI:10.1016/j.lanepe.2025.101233

Fredrik Wickbom , Rakel Bremell , Sarah Thornberg , Jorge Sotoca Fernandez , Beatrice Magnusson , Rasmus Silfver , Aqeel Chaudhry , Kristoffer Kjellröier , Hanna Farahnoosh Afsan , Marcus Bergman , Amel Jumppanen , Malin Johansson , Sascha Östberg , Christian Kamis , Mihai Ölund , Emma Jeppsson , Albert Modin , Anders Santoft , Lovisa Borg , Cathrine Gatzinsky , Johan Undén

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引用次数: 0

摘要

背景：目前的创伤性脑损伤（TBI）初始治疗指南支持决策制定，但它们很少得到验证。斯堪的纳维亚TBI儿童治疗指南（SNC16）的制定是为了在不影响安全性的情况下尽量减少颅脑计算机断层扫描（cCT）的使用，但该指南在现实人群中的表现尚不清楚。我们的目的是确定SNC16在一个大的、实用的儿童队列中的诊断准确性。方法在这项前瞻性、观察性、国际队列研究中，在瑞典和挪威的16个急诊科（ed）进行了前瞻性研究，前瞻性纳入了24小时内出现钝性头部创伤且格拉斯哥昏迷评分为9-15分的儿童（18岁）。主要结局指标是是否存在一个复合变量（临床重要颅内损伤（CIII），包括死亡、神经外科手术、因颅脑损伤住院≥2天，或因病理cCT发现插管≥1天），均在创伤后一周内。次要结局指标是神经外科和重要创伤相关的cCT结果。从2018年4月到2024年5月，共有3012名儿童入组。9例患者符合主要变量CIII (0.30%；9/3012)， 2例患者需要神经外科手术(0.07%；2/3012)， 27例患者在cCT上出现显著的创伤相关发现(0.90%；27/3012)。检测CIII、神经外科和重要cCT结果的点灵敏度为100% (CI 95% 70%-100%) [9/9]；34% - -100% (2/2);87%-100%[27/27])。点特异性分别为41.3%、41.2%和41.6% (CI 95% 40%-43% [1241/3003]；39% - -43% (1241/3010);40%-43%[1241/2985])。CIII、神经外科和重要的cCT结果的阴性预测值为100%（所有CI为95% 99.7%-100.0%）。SNC16指南的应用将导致3.4%（101/3012）的强制性cCT率和41.2%（1241/3012）的儿童立即出院。推荐出院的儿童在主要或次要结局方面均无阳性。解释：SNC16指南的验证在现实世界队列中显示出足够的诊断性能，支持正式实施。非商业（瑞典国家）由Sӧdra sjukv rdsregionen和vetenskappliga r、哈兰德医院和Forskning och Utveckling，哈兰德资助。

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Diagnostic accuracy of the Scandinavian guidelines for minor and moderate head trauma in children: a prospective, pragmatic, validation study

Background

Current guidelines for initial management of traumatic brain injury (TBI) support decision making, but they are rarely validated. The Scandinavian guideline for management of children with TBI (SNC16) was developed to minimise the use of cranial computed tomography (cCT) without compromising safety, but the performance of the guideline in a real-world population is unknown. We aimed to determine the diagnostic accuracy for the SNC16 in a large, pragmatic cohort of children.

Methods

In this prospective, observational, international cohort study in 16 Swedish and Norwegian emergency departments (EDs), children (aged <18 years) with blunt head trauma, presenting within 24 h of injury and a Glasgow Coma Scale of 9–15, were prospectively enrolled. The primary outcome measure was presence of a composite variable (clinically important intracranial injury (CIII) comprised of death, neurosurgery, admission to hospital ward ≥2 days due to head injury, or intubation ≥1 day due to pathological cCT findings), all within one week from trauma. Secondary outcome measures were neurosurgery and significant trauma related findings on cCT.

Findings

A total of 3012 children were enrolled from April 2018 to May 2024. Nine patients fulfilled the primary variable CIII (0.30%; 9/3012), two patients required neurosurgery (0.07%; 2/3012), and 27 patients showed significant trauma related findings on cCT (0.90%; 27/3012). Point sensitivities to detect CIII, neurosurgery and significant cCT findings were 100% (CI 95% 70%–100% [9/9]; 34%–100% [2/2]; and 87%–100% [27/27]). Point specificity was 41.3%, 41.2%, and 41.6% (CI 95% 40%–43% [1241/3003]; 39%–43% [1241/3010]; and 40%–43% [1241/2985]). Negative predictive values were 100% for CIII, neurosurgery and significant cCT findings (CI 95% 99.7%–100.0% for all). Application of the SNC16 guidelines would have resulted in a mandatory cCT rate of 3.4% (101/3012) and immediate discharge from the ED for 41.2% (1241/3012) of children. No children with a discharge recommendation were positive for any primary or secondary outcomes.

Interpretation

Validation of the SNC16 guideline showed adequate diagnostic performance in a real-world cohort, supporting formal implementation.

Funding

Non-commercially (Swedish state) funded by Sӧdra Sjukvårdsregionen and Vetenskapliga Rådet, Hallands Hospital and Forskning och Utveckling, Halland.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.