[Clinical evaluation of evidence-based criteria for CT diagnostics in the treatment of mild traumatic brain injury].
OBJECTIVE
The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre.


METHODS
Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed.


RESULTS
69.5 % of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 % of the patients should have been scanned (p > 0.001). A secondary aggravation caused by a cerebral lesion was found in 3 patients without a CT scan, all of these patients would have been scanned according to the NOC (n. s.). The fraction of patients with alcohol intoxication reached 44 %, a rate that is significantly higher compared to other international studies. These patients were not as often scanned (p < 0.001) and had a shorter hospital stay (p < 0.001) compared to other patients. Duration of hospital stay was prolonged depending on the severity of the brain injury and occurrence of secondary aggravation (p < 0.001).


CONCLUSIONS
Summarising, the high sensitivity of the investigated evidence-based criteria (NOC) could be confirmed, but the application would not have led to a reduction of CT scans within our population.
Schmal
H
H
Orthopädie und Traumatologie, Uniklinik Freiburg. hagen.schmal@freenet.de
Gutmann
B
B
Südkamp
N P
NP
Koestler
W
W
Hammer
T
T
Bley
T
T
Strohm
P C
PC
D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
Klinische Evaluation evidenzbasierter Kriterien für die CT-Diagnostik bei der Behandlung der Commotio cerebri.