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Canadian CT head rule

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
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
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
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
Edward R Melnick
In an electronic health record (EHR) chart review of adult ED trauma patients receiving a head CT from 2008-2013 within 14 community EDs, Sharp et al. estimate that approximately 1/3 of computed tomography (CT) scans in head injury are likely avoidable based on the Canadian CT Head Rule (CCHR).(1) The analysis includes 27,240 adult trauma patients receiving head CTs and uses in-depth chart review of 100 random encounters with 2 independent abstractors (with high inter-rater reliability) to adjust the estimated number of avoidable CTs-the top Choosing Wisely initiative for emergency medicine...
September 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Adam L Sharp, Ganesh Nagaraj, Ellen J Rippberger, Ernest Shen, Clifford J Swap, Matthew A Silver, Taylor McCormick, David R Vinson, Jerome R Hoffman
BACKGROUND: Millions of head computed tomography (CT) scans are ordered annually, but the extent of avoidable imaging is poorly defined. OBJECTIVES: The objective was to determine the prevalence of likely avoidable CT imaging among adults evaluated for head injury in 14 community emergency departments (EDs) in Southern California. METHODS: We conducted an electronic health record (EHR) database and chart review of adult ED trauma encounters receiving a head CT from 2008 to 2013...
2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Thomas C Sauter, Stephan Ziegenhorn, Sufian S Ahmad, Wolf E Hautz, Meret E Ricklin, Alexander Benedikt Leichtle, Georg-Martin Fiedler, Dominik G Haider, Aristomenis K Exadaktylos
BACKGROUND: Patients admitted to emergency departments with traumatic brain injury (TBI) are commonly being treated with oral anticoagulants. In contrast to patients without anticoagulant medication, no guidelines, scores or recommendations exist for the management of mild traumatic brain injury in these patients. We therefore tested whether age as one of the high risk factors of the Canadian head CT rule is applicable to a patient population on oral anticoagulants. METHODS: This cross-sectional analysis included all patients with mild TBI and concomitant oral anticoagulant therapy admitted to the Emergency Department, Inselspital Bern, Switzerland, from November 2009 to October 2014 (n = 200)...
June 1, 2016: Journal of Negative Results in Biomedicine
Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Yumiko Kato, Yasuko Tatewaki, Kei Takase, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi
We compared Canadian computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) in predicting important CT findings in patients with mild traumatic brain injury (TBI). We included 142 consecutive patients with mild TBI [Glasgow coma scale (GCS) 13-15] who showed at least one of the risk factors stated in the CCHR or the NOC. We introduced two scores: a Canadian from the CCHR and a New Orleans from the NOC. A patient's score represented a sum of the number of positive items. We examined the relationship between scores or items and the presence of important CT findings...
2016: SpringerPlus
Emma C M Burns, Anne M Grool, Terry P Klassen, Rhonda Correll, Anna Jarvis, Gary Joubert, Benoit Bailey, Laurel Chauvin-Kimoff, Martin Pusic, Don McConnell, Cheri Nijssen-Jordan, Norm Silver, Brett Taylor, Martin H Osmond
OBJECTIVES: Minor head trauma accounts for a significant proportion of pediatric emergency department (ED) visits. In children younger than 24 months, scalp hematomas are thought to be associated with the presence of intracranial injury (ICI). We investigated which scalp hematoma characteristics were associated with increased odds of ICI in children less than 17 years who presented to the ED following minor head injury and whether an underlying linear skull fracture may explain this relationship...
May 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Oren Tavor, Sirisha Boddu, Abhaya V Kulkarni
PURPOSE: The purpose of this study is to describe the presenting characteristics of a large group of children who required neurosurgical intervention (NSI) following a head injury and to retrospectively assess which of the criteria for imaging from Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), Pediatric Emergency Care Applied Research Network (PECARN), and Canadian Assessment of Tomography for Childhood Head Injury (CATCH) clinical decision rules (CDRs) were met by these patients...
May 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Joshua S Easter, Jason S Haukoos, William P Meehan, Victor Novack, Jonathan A Edlow
IMPORTANCE: Adults with apparently minor head trauma (Glasgow Coma Scale [GCS] scores ≥13 who appear well on examination) may have severe intracranial injuries requiring prompt intervention. Findings from clinical examination can aid in determining which adults with minor trauma have severe intracranial injuries visible on computed tomography (CT). OBJECTIVE: To assess systematically the accuracy of symptoms and signs in adults with minor head trauma in order to identify those with severe intracranial injuries...
December 22, 2015: JAMA: the Journal of the American Medical Association
Desmond Wei Thiam, Si Hui Yap, Shu Ling Chong
INTRODUCTION: High performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population. MATERIALS AND METHODS: This is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected...
September 2015: Annals of the Academy of Medicine, Singapore
Edward R Melnick, Katherine Shafer, Nayeli Rodulfo, Joyce Shi, Erik P Hess, Robert L Wears, Rija A Qureshi, Lori A Post
BACKGROUND: Overuse of computed tomography (CT) for minor head injury continues despite developed and rigorously validated clinical decision rules like the Canadian CT Head Rule (CCHR). Adherence to this sensitive and specific rule could decrease the number of CT scans performed in minor head injury by 35%. But in practice, the CCHR has failed to reduce testing, despite its accurate performance. OBJECTIVES: The objective was to identify nonclinical, human factors that promote or inhibit the appropriate use of CT in patients presenting to the emergency department (ED) with minor head injury...
December 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Ala Faisal Arab, Muhammad Ejaz Ahmed, Anwar E Ahmed, Mohamed Ahmed Hussein, Azzam A Khankan, Riyadh Nasser Alokaili
BACKGROUND: Investigation of unjustified computed tomography (CT) scan in patients with minor head injury is lacking in Saudi Arabia. The purpose of the study was to evaluate the compliance and effectiveness of the Canadian computed tomography head rule (CCHR) in our emergency department (ED) and trauma centre and also to reduce the number of unjustified CT studies of the head in the centre. METHODS: A retrospective study of 368 ED patients with minor head injury was conducted...
December 2015: Neuroradiology Journal
Robab Sadegh, Ehsan Karimialavijeh, Farzaneh Shirani, Pooya Payandemehr, Hooman Bahramimotlagh, Mahtab Ramezani
The objective of this study is to select one of the seven available clinical decision rules for minor head injury, for managing Iranian patients. This was a prospective cohort study evaluating medium- or high-risk minor head injury patients presenting to the Emergency Department. Patients with minor head trauma who were eligible for brain imaging based on seven available clinical decision rules (National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS)-II, Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS), New Orleans, American College of Emergency Physicians (ACEP) Guideline, Scandinavian, and Canadian computed tomography (CT) head rule) were selected...
February 2016: Emergency Radiology
Aziz S Alali, Kirsteen Burton, Robert A Fowler, David M J Naimark, Damon C Scales, Todd G Mainprize, Avery B Nathens
BACKGROUND: Economic evaluations provide a unique opportunity to identify the optimal strategies for the diagnosis and management of traumatic brain injury (TBI), for which uncertainty is common and the economic burden is substantial. OBJECTIVE: The objective of this study was to systematically review and examine the quality of contemporary economic evaluations in the diagnosis and management of TBI. METHODS: Two reviewers independently searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment Database, EconLit, and the Tufts CEA Registry for comparative economic evaluations published from 2000 onward (last updated on August 30, 2013)...
July 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Edward R Melnick, Joshua Keegan, R Andrew Taylor
BACKGROUND: A study was conducted to (1) determine the testing threshold for head computed tomography (CT) in minor head injury in the emergency department using decision analysis with and without costs included in the analysis, (2) to determine which variables have significant impact on the testing threshold, and (3) to compare this calculated testing threshold to the pretest risk estimate previously reported when the Canadian CT Head Rule (CCHR) was applied. It was hypothesized that the CCHR might not identify all patients above the testing threshold...
July 2015: Joint Commission Journal on Quality and Patient Safety
Syed Imran Ayaz, Craig Thomas, Andrew Kulek, Rosa Tolomello, Valerie Mika, Duane Robinson, Patrick Medado, Claire Pearson, Leslie S Prichep, Brian J O'Neil
STUDY OBJECTIVE: We compared the performance of a handheld quantitative electroencephalogram (QEEG) acquisition device to New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), and National Emergency X-Radiography Utilization Study II (NEXUS II) Rule in predicting intracranial lesions on head computed tomography (CT) in acute mild traumatic brain injury in the emergency department (ED). METHODS: Patients between 18 and 80 years of age who presented to the ED with acute blunt head trauma were enrolled in this prospective observational study at 2 urban academic EDs in Detroit, MI...
April 2015: American Journal of Emergency Medicine
Andrzej Żyluk
BACKGROUND AND OBJECTIVE: To determine indications for performing head CT following minor head injuries, which allow reducing number of imaging. MATERIALS AND METHODS: Based on 15 articles dedicated to this topic, the clinical decision rules were systematically analysed. RESULTS: The Canadian Computed Tomography Head Rule was found to be the most reliable instrument meeting these criteria, characterised by excellent sensitivity of 100% and fairly good specificity of 48-77%...
2015: Neurologia i Neurochirurgia Polska
Richard Perez, Jamie C Brehaut, Monica Taljaard, Ian G Stiell, Catherine M Clement, Jeremy Grimshaw
BACKGROUND: Clinical decision rules (CDRs) can be an effective tool for knowledge translation in emergency medicine, but their implementation is often a challenge. This study examined whether the Theory of Planned Behaviour (TPB) could help explain the inconsistent results between the successful Canadian C-Spine Rule (CCR) implementation study and unsuccessful Canadian CT Head Rule (CCHR) implementation study. Both rules are aimed at improving the accuracy and efficiency of emergency department radiography use in clinical contexts that exhibit enormous inefficiency at the present time...
August 7, 2014: Implementation Science: IS
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