Daddy Mata Mbemba MD, PhD, Presenter: Nothing to Disclose

Shunji Mugikura MD, PhD, Abstract Co-Author: Nothing to Disclose

Atsuhiro Nakagawa, Abstract Co-Author: Nothing to Disclose

Takaki Murata MD, Abstract Co-Author: Nothing to Disclose

Li Li MD, PhD, Abstract Co-Author: Nothing to Disclose

Kei Takase, Abstract Co-Author: Nothing to Disclose

Teiji Tominaga, Abstract Co-Author: Nothing to Disclose

Shigeki Kushimoto PhD, Abstract Co-Author: Nothing to Disclose

Shoki Takahashi MD, Abstract Co-Author: Nothing to Disclose

To avoid unnecessary CT, Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC), each containing 7 clinical items, are widely-used guidelines to indicate screening CT in mild traumatic brain injury (TBI) . We aimed to compare the two guidelines in predicting Clinically Important CT Findings (CICF), by introducing two scoring systems.                   

Consecutive 142 mild TBI {Glasgow coma scale (GCS):13-15} patients (age: 17-88 years), who underwent CT examination indicated by either CCHR or NOC, were included. We introduced two 8-graded (0 to 7) scores and assigned them to each patient, Canadian score from CCHR and New Orleans score from NOC: a patient’s score represented a sum of the number of positive items, each of which was rated +1 if present. Two neuroradiologists reviewed screening CT for CICF. In all the GCS13-15 patients, we examined whether both scores were related to CICF by univariate analysis, logistic regression and receiver operator characteristic curve. We also used logistic regression to determine which of the 14 clinical items included in either guideline, independently predicts CICF. Since NOC is applied only for GCS-15 patients, we additionally compared two scoring systems only in GCS-15 group (n=67).                                 

Of 142 mild TBI patients, 49 patients (34.5%) showed CICF. In GCS 13-15 group, both scores showed a significant relationship to CICF (P< 0.05) in univariate analysis. However, in multivariate analyses, only Canadian score was a predictor of CICF (P=0.0130) yielding a better performance (AUC=0.69) than New Orleans score (AUC=0.63). In addition, among all 14 clinical items included in either guidelines, the item of GCS <15 after 2 h, which is included only in CCHR, independently related to CICF (OR=4, P=0.0072). Besides, In GCS-15 group (n=67), only Canadian score showed a significant relationship with CICF in both univariate (P=0.0043) and multivariate (P=0.0128) analyses yielding a better performance (AUC=0.73) than New Orleans score (AUC=0.63).                                                                                                                             

In mild TBI, CCHR was a better predictor of CICF in a tertiary referral hospital in northeastern Japan. Our results are consistent with a big-scale western-study.

In mild TBI, selective use of CT decreases unnecessary irradiation, but improper selection can lead to missing life-threatening lesions. Our study encourages the use of CCHR for efficient CT scanning.

Mata Mbemba, D, Mugikura, S, Nakagawa, A, Murata, T, Li, L, Takase, K, Tominaga, T, Kushimoto, S, Takahashi, S, Screening CT in Mild Traumatic Brain Injury: Comparison of Two Mostly Used Clinical Guidelines in a Tertiary Referral Hospital in Northeastern Japan.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13019223.html