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Canadian CT head rule

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https://www.readbyqxmd.com/read/29753518/application-of-the-canadian-computed-tomography-head-rule-to-patients-with-minimal-head-injury
#1
Kevin Davey, Turandot Saul, Geoffrey Russel, Jonathan Wassermann, Joshua Quaas
STUDY OBJECTIVE: Two clinical decision rules, the Canadian CT Head Rule and the New Orleans Criteria, set the standard to guide clinicians in determining which patients with minor head trauma need computed tomography (CT) imaging. Both rules were derived with patients with minor head injury who had had a loss of consciousness or witnessed disorientation. No evidence exists for evaluating patients and need for CT imaging with minimal head injury; that is, patients who had a head injury but no loss of consciousness or disorientation and therefore would have been excluded from the Canadian CT Head Rule and New Orleans Criteria trials...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29530029/effect-of-clinical-decision-rules-patient-cost-and-malpractice-information-on-clinician-brain-ct-image-ordering-a-randomized-controlled-trial
#2
Ronald W Gimbel, Ronald G Pirrallo, Steven C Lowe, David W Wright, Lu Zhang, Min-Jae Woo, Paul Fontelo, Fang Liu, Zachary Connor
BACKGROUND: The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering...
March 12, 2018: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/29516354/overuse-of-computed-tomography-for-minor-head-injury-in-young-patients-an-analysis-of-promoting-factors
#3
Michaela Cellina, Marta Panzeri, Chiara Floridi, Carlo Maria Andrea Martinenghi, Giulio Clesceri, Giancarlo Oliva
AIM: To assess the amount of computed tomography (CT) scans for minor head injury (MHI) performed in young patients in our emergency department (ED), not indicated by National Institute for Health and Clinical Excellence (NICE) and Canadian Computed Tomography Head Rules (CCHR), and to analyze factors contributing to unnecessary examinations. Secondary objectives were to calculate the effective dose, to establish the number of positive CT and to analyze which of the risk factors are correlated with positivity at CT; finally, to calculate sensitivity and specificity of NICE and CCHR in our population...
March 7, 2018: La Radiologia Medica
https://www.readbyqxmd.com/read/29452747/accuracy-of-clinician-practice-compared-with-three-head-injury-decision-rules-in-children-a-prospective-cohort-study
#4
Franz E Babl, Ed Oakley, Stuart R Dalziel, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Susan Donath, Stephen Hearps, Charlotte Molesworth, Louise Crowe, Silvia Bressan, Mark D Lyttle
STUDY OBJECTIVE: Three clinical decision rules for head injuries in children (Pediatric Emergency Care Applied Research Network [PECARN], Canadian Assessment of Tomography for Childhood Head Injury [CATCH], and Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE]) have been shown to have high performance accuracy. The utility of any of these in a particular setting depends on preexisting clinician accuracy. We therefore assess the accuracy of clinician practice in detecting clinically important traumatic brain injury...
February 13, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29095182/reducing-unnecessary-head-computed-tomography-in-mild-traumatic-brain-injury
#5
Nathaniel John Webster, Nathan Moore, Felicia Stewart
There is growing concern about the frequency of computed tomographic (CT) scans performed for evaluation of adults with suspected mild traumatic brain injury. The Canadian CT Head Rule and the New Orleans Criteria are the most studied head CT decision tools that aid providers in determining which patients do not require a CT scan. This article examines recent research to determine which of these tools has proven to be the most effective at safely reducing the use of head CT scans. The reviewed studies concluded that both the Canadian CT Head Rule and the New Orleans Criteria had similar sensitivities, but the Canadian CT Head Rule showed superior specificity in predicting the presence of a clinically significant brain injury...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29068630/calculated-decisions-canadian-ct-head-injury-trauma-rule
#6
Daniel Runde
No abstract text is available yet for this article.
October 25, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28991814/management-of-traumatic-brain-injury-in-the-emergency-department-guideline-adherence-and-patient-safety
#7
Tomas Vedin, Marcus Edelhamre, Mathias Karlsson, Michael Bergenheim, Per-Anders Larsson
BACKGROUND: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low. AIM: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines. METHODS: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines...
October 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28958987/tablet-based-patient-centered-decision-support-for-minor-head-injury-in-the-emergency-department-pilot-study
#8
Navdeep Singh, Erik Hess, George Guo, Adam Sharp, Brian Huang, Maggie Breslin, Edward Melnick
BACKGROUND: The Concussion or Brain Bleed app is a clinician- and patient-facing electronic tool to guide decisions about head computed tomography (CT) use in patients presenting to the emergency department (ED) with minor head injury. This app integrates a patient decision aid and clinical decision support (using the Canadian CT Head Rule, CCHR) at the bedside on a tablet computer to promote conversations around individualized risk and patients' specific concerns within the ED context...
September 28, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28739290/implementation-of-the-canadian-ct-head-rule-and-its-association-with-use-of-computed-tomography-among-patients-with-head-injury
#9
Adam L Sharp, Brian Z Huang, Tania Tang, Ernest Shen, Edward R Melnick, Arjun K Venkatesh, Michael H Kanter, Michael K Gould
STUDY OBJECTIVE: Approximately 1 in 3 computed tomography (CT) scans performed for head injury may be avoidable. We evaluate the association of implementation of the Canadian CT Head Rule on head CT imaging in community emergency departments (EDs). METHODS: We conducted an interrupted time-series analysis of encounters from January 2014 to December 2015 in 13 Southern California EDs. Adult health plan members with a trauma diagnosis and Glasgow Coma Scale score at ED triage were included...
January 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28700585/validation-of-the-sensitivity-of-the-national-emergency-x-radiography-utilization-study-nexus-head-computed-tomographic-ct-decision-instrument-for-selective-imaging-of-blunt-head-injury-patients-an-observational-study
#10
William R Mower, Malkeet Gupta, Robert Rodriguez, Gregory W Hendey
BACKGROUND: Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28692515/criteria-for-performing-cranial-computed-tomography-for-chinese-patients-with-mild-traumatic-brain-injury-canadian-computed-tomography-head-rule-or-new-orleans-criteria
#11
Xiao-Feng Yang, Yuan-Yuan Meng, Liang Wen, Hao Wang
Computed tomography (CT) provides the primary diagnostic evidence for traumatic brain injury (TBI), but few positive traumatic findings are discovered in patients with mild TBI. In China, there are no existing criteria for selecting patients with mild TBI to undergo CT, and almost all of these patients undergo cranial CT in the emergency department. This retrospective study was performed to evaluate the necessity of cranial CT among patients with mild TBI, as well as the feasibility of 2 popular criteria (Canadian CT head rule [CCHR] and New Orleans Criteria [NOC]) in China...
September 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28540393/computed-tomography-scans-of-the-head-for-adult-patients-with-minor-head-injury-are-clinical-decision-rules-a-necessary-evil
#12
Desmond Wei Tan, Annabelle Mei En Lim, Daniel Yuxuan Ong, Li Lee Peng, Yiong Huak Chan, Irwani Ibrahim, Win Sen Kuan
INTRODUCTION: This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability in the local adult population with minor head injury. METHODS: We conducted a retrospective study of consecutive patients who presented to the adult emergency department (ED) with minor head injury over six months. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR assessed by comparing the recommendations for head computed tomography (CT) scans to its actual usage...
May 25, 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28526667/patient-centered-decision-support-formative-usability-evaluation-of-integrated-clinical-decision-support-with-a-patient-decision-aid-for-minor-head-injury-in-the-emergency-department
#13
Edward R Melnick, Erik P Hess, George Guo, Maggie Breslin, Kevin Lopez, Anthony J Pavlo, Fuad Abujarad, Seth M Powsner, Lori A Post
BACKGROUND: The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions...
May 19, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28268778/a-machine-learning-based-approach-for-identifying-traumatic-brain-injury-patients-for-whom-a-head-ct-scan-can-be-avoided
#14
Somayeh Molaei, Frederick K Korley, S M Reza Soroushmehr, Hayley Falk, Haris Sair, Kevin Ward, Kayvan Najarian
Head CT scan is more often used to evaluate patients with suspected traumatic brain injury (TBI). However, the use of head CT scans in evaluating TBI is costly with low value endeavor. In this paper, we propose a new algorithm and a set of features to help clinicians determine which patients evaluated for TBI need a head CT scan using cost sensitive random forest (CSRF) classifier. We show that random forest (RF) and CSRF are useful methods for identifying patients likely to have a positive head CT scan. The proposed algorithm has superior diagnostic accuracy in comparison to the Canadian head CT algorithm, which is currently the most accurate and widely used algorithm for determining which TBI patients need a head CT scan...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28251880/choosing-wisely-canada%C3%A2-five-tests-procedures-and-treatments-to-question-in-emergency-medicine
#15
Amy H Y Cheng, Sam Campbell, Lucas B Chartier, Tom Goddard, Kirk Magee, Jill McEwen, Atul K Kapur, Brian R Holroyd, Suneel Upadhye, Stephanie Couperthwaite, Brian H Rowe
OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned...
July 2017: CJEM
https://www.readbyqxmd.com/read/28226969/a-machine-learning-based-approach-for-identifying-traumatic-brain-injury-patients-for-whom-a-head-ct-scan-can-be-avoided
#16
Somayeh Molaei, Frederick K Korley, S M Reza Soroushmehr, Hayley Falk, Haris Sair, Kevin Ward, Kayvan Najarian, Somayeh Molaei, Frederick K Korley, S M Reza Soroushmehr, Hayley Falk, Haris Sair, Kevin Ward, Kayvan Najarian, Frederick K Korley, Hayley Falk, Kevin Ward, S M Reza Soroushmehr, Haris Sair, Kayvan Najarian, Somayeh Molaei
Head CT scan is more often used to evaluate patients with suspected traumatic brain injury (TBI). However, the use of head CT scans in evaluating TBI is costly with low value endeavor. In this paper, we propose a new algorithm and a set of features to help clinicians determine which patients evaluated for TBI need a head CT scan using cost sensitive random forest (CSRF) classifier. We show that random forest (RF) and CSRF are useful methods for identifying patients likely to have a positive head CT scan. The proposed algorithm has superior diagnostic accuracy in comparison to the Canadian head CT algorithm, which is currently the most accurate and widely used algorithm for determining which TBI patients need a head CT scan...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/27836434/overuse-of-head-ct-examinations-for-the-investigation-of-minor-head-trauma-analysis-of-contributing-factors
#17
Eyal Klang, Arkadi Beytelman, Dan Greenberg, Jacob Or, Larisa Guranda, Eli Konen, Eyal Zimlichman
PURPOSE: The aim of this study was to estimate the amount of CT studies performed in the emergency department of a tertiary hospital that are not indicated by Canadian CT Head Rule (CCHR) guidelines and to analyze factors that contribute to unnecessary examinations. METHODS: A total of 955 brain CT examinations performed for minor head injuries were randomly retrospectively selected. Medical records were assessed for the following parameters: demographics, cause of head trauma, and referring physician's seniority and specialty...
February 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/27745699/comparison-of-the-canadian-ct-head-rule-and-the-new-orleans-criteria-in-patients-with-minor-head-injury-in-a-spanish-hospital
#18
COMPARATIVE STUDY
Joaquín Valle Alonso, Francisco Javier Fonseca Del Pozo, Manuel Vaquero Álvarez, Elisa Lopera Lopera, Marisol Garcia Segura, Ricardo García Arévalo
BACKGROUND AND OBJECTIVE: To compare two scales for assessment of patients with mild head injury. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) according to their diagnostic accuracy in patients attending an emergency department, and to determine the most important predictive values. METHOD: Cross-sectional study in a first-level Hospital in the period of January 2011 to January 2013. Patients with mild head injury criteria were included. All the patients underwent a computed tomography (CT) of the head as part of internal protocol and the CCHR and NOC criteria were recorded for each patient...
December 16, 2016: Medicina Clínica
https://www.readbyqxmd.com/read/27717240/attitudes-toward-evidence-based-clinical-decision-support-tools-to-reduce-exposure-to-ionizing-radiation-the-canadian-ct-head-rule
#19
Raymond Zakhari, Susan E Sterrett
BACKGROUND AND PURPOSE: A large degree of variation in clinical practice exists among clinicians evaluating and treating individuals with minor head injuries. Noncontrast head computerized tomography (CT) scans are commonly used to assess for intracranial damage in patients presenting with head injury. This practice is not supported by the evidence and poses harm to patients by increasing exposure to ionizing radiation. This form of radiation exposure increases the risk of developing cancers over the course of the individual's life, and further strains the limited resources of the healthcare system...
December 2016: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/27617902/big-versus-small-data-and-the-generalizability-of-the-rate-of-computed-tomography-overuse-in-minor-head-injury
#20
LETTER
Edward R Melnick
No abstract text is available yet for this article.
March 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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