Utility of clinical decision rule for intensive care unit admission in patients with traumatic intracranial hemorrhage.
BACKGROUND
Recent literature suggests the majority of traumatic intracranial hemorrhage does not require intervention. One recently described clinical decision rule was sensitive in identifying patients requiring critical care interventions in an urban setting. We sought to validate its effectiveness in our predominately rural setting.


METHODS
A retrospective study was conducted of adult patients with traumatic intracranial hemorrhage. The rule, based on age, initial Glasgow coma scale score, and presence of a non-isolated head injury, was applied to externally validate the previously reported findings.


RESULTS
In our population, the rule displayed a sensitivity of 0.923, specificity of 0.251, positive predictive value of 0.393, and negative predictive value of 0.862. The area under curve was 0.587. While our population has a similar adjusted head injury severity score as that from which the rule was developed, significant differences in age and intracranial hemorrhage pattern were noted.


CONCLUSIONS
The rule displayed decreased performance in our population, most likely secondary to differences in age and intracranial hemorrhage patterns. Prospective evaluation and cost-savings analysis are appropriate subsequent steps for the rule.
Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
Brandt D
BD
Whitehurst
Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
Jared
J
Reyes
Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA; Department of Medical Education, Via Christi Hospital Saint Francis, Wichita, KS, USA.
Stephen D
SD
Helmer
Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA; Department of Trauma Services, Via Christi Hospital Saint Francis, Wichita, KS, USA. Electronic address: James.Haan.Research@viachristi.org.
James M
JM
Haan
D000367:Age Factors; D000067401:Blood Alcohol Content; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D020198:Intracranial Hemorrhage, Traumatic / Q000453:epidemiology*; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013599:Systole; D014193:Trauma Centers
D000067401:Blood Alcohol Content
Clinical decision rule; Intensive care unit admission; Trauma; Traumatic intracranial hemorrhage; Triage