ACEP's Recommendations for Brain Computed Tomography Scan in Adult Minor Head Trauma Patients; a Diagnostic Accuracy Study

Abstract

Introduction: Some clinical decision rules have been developed to identify minor head trauma (MHT) patients in need of brain computed tomography (CT) scan for detection of possible traumatic brain injuries (TBIs). This study aimed to evaluate the performance of American College of Emergency Physicians (ACEP) recommendations in this regard. Methods: This study is a cross-sectional study of MHT (GCS: 13-15) cases who referred to emergency department of a level one trauma center, Mashhad, Iran, from October 2017 to March 2018. The screening performance characteristics of ACEP recommendations for performing brain CT scan in these patients were calculated. Results: 500 patients with a mean age of 37.97 ± 15.96 years were evaluated. Based on level one recommendations, 73 (14.6 %) patients had to be assessed by brain CT scan. 67 (91.8%) were assessed and 6 (8.2%) were not assessed based on decision of their in-charge physician. According to level two recommendations, 125 (25.0%) patients did not need brain CT scan, 85 (68%) of whom had been assessed (all normal). Performing brain CT scan according to the level one recommendation of ACEP’s clinical policy showed 29.6% sensitivity (95% CI: 13.75 to 50.18) and 86.3% specificity (95% CI: 82.68 to 89.14). The overall ACEP’s clinical policy for neuroimaging of adults with MTBI showed sensitivity and specificity of 92.59% (95% CI: ‎75.71 to 99.09) and 26.4% (95% CI: 22.51 to 30.65), respectively. Conclusion: ACEP’s clinical policy has a high-level sensitivity for using brain CT scan in detection of probable TBI in patients with MHT.

Keywords

• Craniocerebral Trauma; Brain; Tomography, X-Ray Computed; Health Planning Guidelines