Evaluation of Clinical Characteristics and CT Decision Rules in Elderly Patients with Minor Head Injury: A Prospective Multicenter Cohort Study.
Sophie Maria CoffengKelly A FoksCrispijn L van den BrandKorné JellemaDiederik W J DippelBram JacobsJoukje van der NaaltPublished in: Journal of clinical medicine (2023)
Age is variably described as a minor or major risk factor for traumatic intracranial lesions after head injury. However, at present, no specific CT decision rule is available for elderly patients with minor head injury (MHI). The aims of this prospective multicenter cohort study were to assess the performance of existing CT decision rules for elderly MHI patients and to compare the clinical and CT characteristics of elderly patients with the younger MHI population. Thirty-day mortality between two age groups (cutoff ≥ 60 years), along with clinical and CT characteristics, was evaluated with four CT decision rules: the National Institute for Health and Care Excellence (NICE) guideline, the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the CT Head Injury Patients (CHIP) rule. Of the 5517 MHI patients included, 2310 were aged ≥ 60 years. Elderly patients experienced loss of consciousness (17% vs. 32%) and posttraumatic amnesia (23% vs. 31%) less often, but intracranial lesions (13% vs. 10%), neurological deterioration (1.8% vs. 0.2%), and 30-day mortality (2.0% vs. 0.1%) were more frequent than in younger patients (all p < 0.001). Elderly patients with age as their only risk factor showed intracranial lesions in 5% (NOC and CHIP) to 8% (CCHR and NICE) of cases. The sensitivity of decision rules in the elderly patients was 60% (CCHR) to 97% (NOC) when age was excluded as a risk factor. Current risk factors considered when evaluating elderly patients show lower sensitivity to identify intracranial abnormalities, despite more frequent intracranial lesions. Until age-specific CT decision rules are developed, it is advisable to scan every elderly patient with an MHI.
Keyphrases
- computed tomography
- risk factors
- end stage renal disease
- dual energy
- image quality
- contrast enhanced
- optic nerve
- ejection fraction
- newly diagnosed
- chronic kidney disease
- healthcare
- positron emission tomography
- magnetic resonance imaging
- peritoneal dialysis
- public health
- type diabetes
- cardiovascular disease
- clinical trial
- decision making
- middle aged
- circulating tumor cells
- climate change
- optical coherence tomography
- risk assessment
- quality improvement
- brain injury
- social media
- coronary artery disease
- patient reported
- high throughput
- pain management
- cerebral ischemia