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

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.