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Using Canadian CT head rule in a developing nation: Validation and comparing utilisation by emergency physicians and

Ishan Lamba1, Avinav Luthra1, Varsha Shinde1

  • 1Department of Emergency Medicine, Dr DY Patil Medical College, Pimpri, DY Patil Vidyapeeth Pune, Maharashtra, India.

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The Canadian CT Head Rule (CCHR) shows 100% sensitivity for identifying patients with minor traumatic brain injury (TBI) needing a CT scan, though its specificity is low. Emergency physicians utilized the CCHR more than neurosurgeons.

Keywords:
CCHRCanadian CT head ruleHead injury in IndiaHead traumaTBI

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Area of Science:

  • Emergency Medicine
  • Neurosurgery
  • Radiology

Background:

  • Minor traumatic brain injury (TBI) is a common emergency department presentation.
  • Accurate identification of patients requiring neuroimaging is crucial for effective TBI management.
  • The Canadian CT Head Rule (CCHR) is a validated decision tool for TBI assessment.

Purpose of the Study:

  • To evaluate the validity of the Canadian CT Head Rule (CCHR) in an Indian emergency department for minor TBI cases.
  • To compare neuroradiology referral patterns between emergency physicians (EPs) and neurosurgeons.
  • To assess the utility of CCHR in guiding CT scan decisions for TBI patients.

Main Methods:

  • Prospective study conducted over 12 months (July 2019-July 2020).
  • 101 patients with minor TBI met inclusion criteria and were assessed using CCHR.
  • Neurosurgeon consultation determined final decisions, especially in cases of disagreement with EP's CCHR assessment.

Main Results:

  • CCHR identified 62 patients requiring CT scans; 16 had intracranial hemorrhages or contusions.
  • All 39 patients not meeting CCHR criteria had normal CT scans.
  • CCHR demonstrated 100% sensitivity and 45.8% specificity for detecting TBI requiring CT scan.

Conclusions:

  • The CCHR is a highly sensitive screening tool for TBI patients needing CT scans, despite low specificity.
  • Emergency physicians showed greater adherence to CCHR compared to neurosurgeons.
  • ED residents expressed comfort using CCHR via mobile applications.