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Eur J Trauma Emerg Surg. 2019 May 14. doi: 10.1007/s00068-019-01145-x. [Epub ahead of print]

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety.

Author information

1
Clinical Sciences, Helsingborg, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden. tvedin@gmail.com.
2
Department of Clinical Chemistry, Center for Clinical Research, Centralsjukhuset, Karlstad, Sweden.
3
Clinical Sciences, Helsingborg, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden.
4
Centralsjukhuset i Karlstad, Rosenborgsgatan 9, 652 30, Karlstad, Sweden.

Abstract

PURPOSE:

Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention.

METHODS:

A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived "low-risk proposal" and applied retrospectively to the cohort.

RESULTS:

Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention.

CONCLUSION:

For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.

KEYWORDS:

Brain injuries; Intracranial hemorrhage; Practice guidelines as topic; Tomography; Traumatic; X-ray computed

PMID:
31089789
DOI:
10.1007/s00068-019-01145-x

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