Validation of the Scandinavian neurotrauma committee guidelines – A retrospective study in region Örebro county

TL;DR

This study validates the Scandinavian Neurotrauma Committee guidelines for predicting which traumatic brain injury patients need CT scans, finding them effective but with room for improvement in adherence.

Contribution

The study provides empirical validation of the guidelines in a real-world setting and identifies opportunities to improve adherence and safety.

Findings

The guidelines showed 95% sensitivity but only 29% specificity in predicting CT scan need.

Adherence to the guidelines was 56%, with non-adherence mainly due to lack of S100B analysis.

Including age as a rule-in criterion for CT scans could enhance patient safety.

Abstract

Traumatic Brain Injury (TBI) is a global health concern and a leading cause of trauma-related death worldwide. Computed tomography (CT) scan is the gold standard for screening for intracranial bleeding following TBI. Most cases of TBI are mild, with negative CT scans. Different instruments and guidelines are employed to better predict which patients need a CT scan and to minimise unnecessary radiation exposure and save resources. One such instrument is the Scandinavian Neurotrauma Committee guidelines.

To validate and examine adherence to the Scandinavian Neurotrauma Committee guidelines in Region Örebro County.

We executed a retrospective study with review of patient records and data analysis. Descriptive and comparative statistics were used, along with binary logistic regression analysis to account for confounding factors.

A total of 505 cases were reviewed. Sensitivity of the guidelines was measured at 95% with specificity at 29%. The positive and negative predictive values were 0.77 and 0.69, respectively. A total of 17 false negative cases were found. One case required surgery, during which a chronic subdural hematoma was identified. Adherence to guidelines was 56%, with the lack of analysis of S100B primarily accounting for non-adherence. A total of 54 CT scans were performed outside of guideline indications.

The guidelines can effectively predict which patients need a CT scan. Increased adherence could potentially decrease the number of CT scans, while inclusion of older age limit as an independent rule-in law for CT scans would increase patient safety.

•The Scandinavian Neurotrauma Committee Guidelines is a sensitive screening tool.•Adherence to guidelines in the emergency department can be improved.•Improved adherence could lead to fewer CT scans being performed.•Age as a sole rule-in criterion for CT scan should be considered in future revision.

The Scandinavian Neurotrauma Committee Guidelines is a sensitive screening tool.

Adherence to guidelines in the emergency department can be improved.

Improved adherence could lead to fewer CT scans being performed.

Age as a sole rule-in criterion for CT scan should be considered in future revision.

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