title: Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study.
abstract: OBJECTIVE
  The New Orleans Criteria and the Canadian CT Head Rule have been developed to decrease the number of normal computed tomography (CT) results in mild head injury. We compare the performance of both decision rules for identifying patients with intracranial traumatic lesions and those who require an urgent neurosurgical intervention after mild head injury.
  
  
  METHODS
  This was an observational cohort study performed between 2008 and 2011 on patients with mild head injury who were aged 10 years or older. We collected prospectively clinical head CT scan findings and outcome. Primary outcome was need for neurosurgical intervention, defined as either death or craniotomy, or the need of intubation within 15 days of the traumatic event. Secondary outcome was the presence of traumatic lesions on head CT scan. New Orleans Criteria and Canadian CT Head Rule decision rules were compared by using sensitivity specifications and positive and negative predictive value.
  
  
  RESULTS
  We enrolled 1,582 patients. Neurosurgical intervention was performed in 34 patients (2.1%) and positive CT findings were demonstrated in 218 patients (13.8%). Sensitivity and specificity for need for neurosurgical intervention were 100% (95% confidence interval [CI] 90% to 100%) and 60% (95% CI 44% to 76%) for the Canadian CT Head Rule and 82% (95% CI 69% to 95%) and 26% (95% CI 24% to 28%) for the New Orleans Criteria. Negative predictive values for the above-mentioned clinical decision rules were 100% and 99% and positive values were 5% and 2%, respectively, for the Canadian CT Head Rule and New Orleans Criteria. Sensitivity and specificity for clinical significant head CT findings were 95% (95% CI 92% to 98%) and 65% (95% CI 62% to 68%) for the Canadian CT Head Rule and 86% (95% CI 81% to 91%) and 28% (95% CI 26% to 30%) for the New Orleans Criteria. A similar trend of results was found in the subgroup of patients with a Glasgow Coma Scale score of 15.
  
  
  CONCLUSIONS
  For patients with mild head injury, the Canadian CT Head Rule had higher sensitivity than the New Orleans Criteria, with higher negative predictive value. The question of whether the use of the Canadian CT Head Rule would have a greater influence on head CT scan reduction requires confirmation in real clinical practice.
authors.affiliation: Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Wahid
authors.initials: W
authors.lastname: Bouida
authors.forename: Soudani
authors.initials: S
authors.lastname: Marghli
authors.forename: Sami
authors.initials: S
authors.lastname: Souissi
authors.forename: Hichem
authors.initials: H
authors.lastname: Ksibi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Methammem
authors.forename: Habib
authors.initials: H
authors.lastname: Haguiga
authors.forename: Sonia
authors.initials: S
authors.lastname: Khedher
authors.forename: Hamdi
authors.initials: H
authors.lastname: Boubaker
authors.forename: Kaouthar
authors.initials: K
authors.lastname: Beltaief
authors.forename: Mohamed Habib
authors.initials: MH
authors.lastname: Grissa
authors.forename: Mohamed Naceur
authors.initials: MN
authors.lastname: Trimech
authors.forename: Wiem
authors.initials: W
authors.lastname: Kerkeni
authors.forename: Nawfel
authors.initials: N
authors.lastname: Chebili
authors.forename: Imen
authors.initials: I
authors.lastname: Halila
authors.forename: Imen
authors.initials: I
authors.lastname: Rejeb
authors.forename: Riadh
authors.initials: R
authors.lastname: Boukef
authors.forename: Noureddine
authors.initials: N
authors.lastname: Rekik
authors.forename: Bechir
authors.initials: B
authors.lastname: Bouhaja
authors.forename: Mondher
authors.initials: M
authors.lastname: Letaief
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D055815:Young Adult