title: Head CT scan in Iranian minor head injury patients: evaluating current decision rules.
abstract: 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. Subjects were underwent a non-contrast axial spiral head CT scan. The outcome was defined as abnormal and normal head CT scan. Univariate analysis and stepwise linear regression were applied to show the best combination of risk factors for detecting CT scan abnormalities. Five hundred patients with minor head trauma were underwent brain CT scan. The following criteria were derived by stepwise linear regression: Glasgow Coma Scale (GCS) less than 15, confusion, signs of basal skull fracture, drug history of warfarin, vomiting more than once, loss of consciousness, focal neurologic deficit, and age over 65 years. This model has 86.15 % (75.33-93.45 %) sensitivity and 46.44 % (46.67-51.25 %) specificity in detecting minor head injury patients with CT scan abnormalities (95 % confidence interval). Of seven decision rules, only the Canadian CT Head Rule possesses seven of the eight high-risk factors associated with abnormal head CT results which were identified by this study. This study underlines the Canadian CT Head Rule's utility in Iranian minor head injury patients. Our study encourages researchers to evaluate available guidelines in different communities.
authors.affiliation: Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Sadegh
authors.affiliation: Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Kargar Ave., P.O. Box: 14117-13137, Tehran, Iran. e-karimi@sina.tums.ac.ir.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Karimialavijeh
authors.affiliation: Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Kargar Ave., P.O. Box: 14117-13137, Tehran, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Shirani
authors.affiliation: Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Pooya
authors.initials: P
authors.lastname: Payandemehr
authors.affiliation: Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hooman
authors.initials: H
authors.lastname: Bahramimotlagh
authors.affiliation: Shahidbeheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mahtab
authors.initials: M
authors.lastname: Ramezani
mesh_terms: D000367:Age Factors; D000368:Aged; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
keywords: Computed tomography; Decision modeling; Head injury