Comparison of scoring systems for patients with head injury presenting to the emergency department

The present study aimed to compare the National Emergency X-Radiography Utilization Study II (NEXUS-II), New Orleans Criteria (NOC), Canadian Computed Tomography (CT) Head Rule (CCTHR) scoring systems, and Advanced Trauma Life Support (ATLS^®) 10th edition algorithm in patients with head injury presenting to the emergency department and to investigate the effectiveness of these scoring systems in determining injury severity and the need for cranial CT scanning.

This prospective and observational study was conducted in a tertiary care emergency medicine clinic. The study included 794 adult patients who had a Glasgow Coma Scale (GCS) score ≥ 13, and were considered as having minor head injury. Patients included in the study were categorized as having low or high risk according to the CCTHR, NOC, NEXUS-II scores, and ATLS algorithm.

The mean age of the patients was 40.7 ± 18.7 years, and 592 (74.6%) were male. The proportion of patients considered as having high risk was 27.7%, 84.8%, and 34.5% according to CCTHR, NOC, and NEXUS-II, respectively. According to the ATLS, 14.7% and 14.1% of the patients were considered at medium risk and high risk, respectively. CT scanning was performed in 757 (95.3%) patients, and pathologic findings were detected in 18 patients (2.3%). NOC in contrary showed a sensitivity of 100% but a specificity of 15.6%.

In our region, there was no significant difference among the CCTHR, NEXUS-II systems, and ATLS algorithm regarding the accuracy of pathological findings in patients with head injury; any of these systems can be used in clinical practice and determining CT scan necessity. Although the sensitivity of the NOC system is very high, it has been observed that its low specificity may lead to a large number of unnecessary CT scans, which may increase the patient-based cost and waiting time in the emergency department.