SUMMARY Background In mild head injury, predictors to select patients for computed tomography (CT) and/or to plan proper management are needed. The strength of evidence of published recommendations is insufficient for current use. We assessed the diagnostic accuracy and the clinical validity of the proposal of the Neurotraumatology Committee of the World Federation of Neurosurgical Societies on mild head injury from an Emergency department perspective. Methods In a 3-year period, 5,578 adolescent and adult subjects were prospectively recruited and managed according to the proposed protocol. Outcome measures were: a) any post-traumatic injury; b) need for neurosurgical intervention; c) unfavorable outcome (death, permanent vegetative state or severe disability) after 6 months. The predictive value of a model based on 5 variables (Glasgow coma score, clinical findings, risk factors, neurological deficits, skull fracture) was tested by logistic regression analysis. Findings 327 patients (5.9%) had intracranial post-traumatic injuries at first CT evaluation. In 16 cases (0.3%) previously undiagnosed injuries were detected after re-evaluation within 7 days. Neurosurgical intervention was needed in 71 patients (1.3%) and an unfavorable outcome occurred in 39 cases (0.7%). The area under the ROC curve of the variables in predicting post-traumatic injuries was 0.906±0.009 (sensitivity 70.0%, specificity 94.1% at best cut-off), neurosurgical intervention was 0.926±0.016 (sensitivity 81.7%, specificity 94.1%) and unfavorable outcome was 0.953±0.014 (sensitivity 88.1%, specificity 95.1%). Interpretation The variables prove highly accurate in the prediction of clinically meaningful outcomes, when applied to a consecutive set of patients with mild head injury in the clinical setting of a 1st level emergency department.

Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury

MARCHESINI REGGIANI, GIULIO;MORSELLI LABATE, ANTONIO MARIA;
2004

Abstract

SUMMARY Background In mild head injury, predictors to select patients for computed tomography (CT) and/or to plan proper management are needed. The strength of evidence of published recommendations is insufficient for current use. We assessed the diagnostic accuracy and the clinical validity of the proposal of the Neurotraumatology Committee of the World Federation of Neurosurgical Societies on mild head injury from an Emergency department perspective. Methods In a 3-year period, 5,578 adolescent and adult subjects were prospectively recruited and managed according to the proposed protocol. Outcome measures were: a) any post-traumatic injury; b) need for neurosurgical intervention; c) unfavorable outcome (death, permanent vegetative state or severe disability) after 6 months. The predictive value of a model based on 5 variables (Glasgow coma score, clinical findings, risk factors, neurological deficits, skull fracture) was tested by logistic regression analysis. Findings 327 patients (5.9%) had intracranial post-traumatic injuries at first CT evaluation. In 16 cases (0.3%) previously undiagnosed injuries were detected after re-evaluation within 7 days. Neurosurgical intervention was needed in 71 patients (1.3%) and an unfavorable outcome occurred in 39 cases (0.7%). The area under the ROC curve of the variables in predicting post-traumatic injuries was 0.906±0.009 (sensitivity 70.0%, specificity 94.1% at best cut-off), neurosurgical intervention was 0.926±0.016 (sensitivity 81.7%, specificity 94.1%) and unfavorable outcome was 0.953±0.014 (sensitivity 88.1%, specificity 95.1%). Interpretation The variables prove highly accurate in the prediction of clinically meaningful outcomes, when applied to a consecutive set of patients with mild head injury in the clinical setting of a 1st level emergency department.
A Fabbri; F Servadei; G Marchesini Reggiani; AM Morselli-Labate; M Dente; T Iervese; M Spada; A Vandelli
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/4533
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