The Florida Geriatric Head Trauma CT Clinical Decision Rule

被引：1

作者：

Shih, Richard D. ^{[1
,2
]}

Alter, Scott M. ^{[1
,2
,3
]}

Wells, Mike ^{[1
]}

Solano, Joshua J. ^{[1
,2
,3
]}

Engstrom, Gabriella ^{[1
]}

Clayton, Lisa M. ^{[1
,2
,3
]}

Hughes, Patrick G. ^{[1
,2
,3
]}

Goldstein, Lara ^{[4
]}

Lottenberg, Lawrence ^{[1
,5
]}

Ouslander, Joseph G. ^{[1
]}

机构：

[1] Florida Atlantic Univ, Charles E Schmidt Coll Med, 777 Glades Rd, Boca Raton, FL 33431 USA

[2] Delray Med Ctr, Depatment Emergency Med, Delray Beach, FL USA

[3] Bethesda Hosp East, Dept Emergency Med, Boynton Beach, FL USA

[4] Mem Healthcare Syst, Dept Emergency Med, Hollywood, FL USA

[5] St Marys Hosp, Dept Surg, W Palm Beach, FL USA

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2024年 / 72卷 / 09期

关键词：

clinical decision rule; CT scan; head trauma; NEW-ORLEANS CRITERIA; COMPUTED-TOMOGRAPHY; EMERGENCY-DEPARTMENT; BRAIN-INJURY; INTRACRANIAL HEMORRHAGE; ELDERLY-PATIENTS; RESEARCH AGENDA; UNITED-STATES; OLDER-ADULTS; FALLS;

D O I：

10.1111/jgs.19057

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

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.

引用

页码：2738 / 2751

页数：14

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