頭部外傷,CTとるべきか?
頭部外傷,CTとるべきか?
1)
Neuroimaging Clin N Am. 2003 May;13(2):273-82.
Examining the role of cranial CT in the evaluation of patients with minor head injury: a systematic review.
打撲時の意識障害または記憶障害あればとらねばならない
2)
ACP J Club. 2006 Mar-Apr;144(2):53.
The Canadian CT Head Rule was as sensitive as, but more specific than, the New Orleans Criteria for identifying minor head injury
JAMA. 2005 Sep 28;294(12):1511-8.
Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.
CCHR included
5 high-risk features
・GCS score < 15 at 2 h after injury
・suspected open or depressed skull fracture
・any sign of basal skull fracture
・2 episodes of vomiting
・and age 65 y
2 medium-risk features
・amnesia before impact 30 min
・dangerous mechanism
(It was assessed in all 2707 patients with a GCS score 13)
→
(GCS 13 to 15)
Need for neurosurgical intervention
Sensitivity 100%, Specificity 66%, +LR 2.6
Clinically important brain injury
Sensitivity 100%, Specificity 41%, +LR 1.7
(GCS 15)
Need for neurosurgical intervention
Sensitivity 100%, Specificity 76%, +LR 4.2
Clinically important brain injury
Sensitivity 100%, Specificity 51%, +LR 2.0
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