Klinische Evaluation evidenzbasierter Kriterien für die CT-Diagnostik bei der Behandlung der Commotio cerebri

H Schmal, B Gutmann, N P Südkamp, W Koestler, T Hammer, T Bley, P C Strohm

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

AIM: The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre.

PATIENTS AND METHODS: Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed.

RESULTS: 69.5 % of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 % of the patients should have been scanned (p > 0.001). A secondary aggravation caused by a cerebral lesion was found in 3 patients without a CT scan, all of these patients would have been scanned according to the NOC (n. s.). The fraction of patients with alcohol intoxication reached 44 %, a rate that is significantly higher compared to other international studies. These patients were not as often scanned (p < 0.001) and had a shorter hospital stay (p < 0.001) compared to other patients. Duration of hospital stay was prolonged depending on the severity of the brain injury and occurrence of secondary aggravation (p < 0.001).

CONCLUSION: Summarising, the high sensitivity of the investigated evidence-based criteria (NOC) could be confirmed, but the application would not have led to a reduction of CT scans within our population.

OriginalsprogTysk
TidsskriftZeitschrift fur Orthopadie und Unfallchirurgie
Vol/bind146
Udgave nummer5
Sider (fra-til)595-601
Antal sider7
ISSN1864-6697
DOI
StatusUdgivet - 11. okt. 2008

Fingeraftryk

Length of Stay
Alcoholic Intoxication
Hospital Emergency Service
Inpatients
Population

Emneord

  • Brain Injuries
  • Evidence-Based Medicine
  • Female
  • Germany
  • Humans
  • Male
  • Prevalence
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed

Citer dette

Schmal, H ; Gutmann, B ; Südkamp, N P ; Koestler, W ; Hammer, T ; Bley, T ; Strohm, P C. / Klinische Evaluation evidenzbasierter Kriterien für die CT-Diagnostik bei der Behandlung der Commotio cerebri. I: Zeitschrift fur Orthopadie und Unfallchirurgie. 2008 ; Bind 146, Nr. 5. s. 595-601.
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title = "Klinische Evaluation evidenzbasierter Kriterien f{\"u}r die CT-Diagnostik bei der Behandlung der Commotio cerebri",
abstract = "AIM: The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre.PATIENTS AND METHODS: Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed.RESULTS: 69.5 {\%} of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 {\%} of the patients should have been scanned (p > 0.001). A secondary aggravation caused by a cerebral lesion was found in 3 patients without a CT scan, all of these patients would have been scanned according to the NOC (n. s.). The fraction of patients with alcohol intoxication reached 44 {\%}, a rate that is significantly higher compared to other international studies. These patients were not as often scanned (p < 0.001) and had a shorter hospital stay (p < 0.001) compared to other patients. Duration of hospital stay was prolonged depending on the severity of the brain injury and occurrence of secondary aggravation (p < 0.001).CONCLUSION: Summarising, the high sensitivity of the investigated evidence-based criteria (NOC) could be confirmed, but the application would not have led to a reduction of CT scans within our population.",
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author = "H Schmal and B Gutmann and S{\"u}dkamp, {N P} and W Koestler and T Hammer and T Bley and Strohm, {P C}",
year = "2008",
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Klinische Evaluation evidenzbasierter Kriterien für die CT-Diagnostik bei der Behandlung der Commotio cerebri. / Schmal, H; Gutmann, B; Südkamp, N P; Koestler, W; Hammer, T; Bley, T; Strohm, P C.

I: Zeitschrift fur Orthopadie und Unfallchirurgie, Bind 146, Nr. 5, 11.10.2008, s. 595-601.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Klinische Evaluation evidenzbasierter Kriterien für die CT-Diagnostik bei der Behandlung der Commotio cerebri

AU - Schmal, H

AU - Gutmann, B

AU - Südkamp, N P

AU - Koestler, W

AU - Hammer, T

AU - Bley, T

AU - Strohm, P C

PY - 2008/10/11

Y1 - 2008/10/11

N2 - AIM: The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre.PATIENTS AND METHODS: Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed.RESULTS: 69.5 % of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 % of the patients should have been scanned (p > 0.001). A secondary aggravation caused by a cerebral lesion was found in 3 patients without a CT scan, all of these patients would have been scanned according to the NOC (n. s.). The fraction of patients with alcohol intoxication reached 44 %, a rate that is significantly higher compared to other international studies. These patients were not as often scanned (p < 0.001) and had a shorter hospital stay (p < 0.001) compared to other patients. Duration of hospital stay was prolonged depending on the severity of the brain injury and occurrence of secondary aggravation (p < 0.001).CONCLUSION: Summarising, the high sensitivity of the investigated evidence-based criteria (NOC) could be confirmed, but the application would not have led to a reduction of CT scans within our population.

AB - AIM: The mild traumatic brain injury (MTBI) is one of the most frequent diseases treated in emergency departments. Extensive studies addressing evidence-based treatment criteria have been published, the indication for CT scans depending on clinical symptoms appeared to be one of the critical issues. In this study, the question was raised whether or not the developed evidence-based criteria may be transferred to the patients of a German level 1 trauma centre.PATIENTS AND METHODS: Within 2 years (2004/05) 1841 patients with a traumatic brain injury were treated, 1042 patients with a mild traumatic brain injury and with an age over 14 years were included in the study. The indication for a head CT scan was checked by criteria of a phase 3 study (New Orleans Criteria - NOC). Furthermore, the length of hospitalisation, number and character of secondary aggravation, and kind of inpatient care were analysed.RESULTS: 69.5 % of our patients were diagnosed with the help of a CT scan, according to the evidence criteria 98.8 % of the patients should have been scanned (p > 0.001). A secondary aggravation caused by a cerebral lesion was found in 3 patients without a CT scan, all of these patients would have been scanned according to the NOC (n. s.). The fraction of patients with alcohol intoxication reached 44 %, a rate that is significantly higher compared to other international studies. These patients were not as often scanned (p < 0.001) and had a shorter hospital stay (p < 0.001) compared to other patients. Duration of hospital stay was prolonged depending on the severity of the brain injury and occurrence of secondary aggravation (p < 0.001).CONCLUSION: Summarising, the high sensitivity of the investigated evidence-based criteria (NOC) could be confirmed, but the application would not have led to a reduction of CT scans within our population.

KW - Brain Injuries

KW - Evidence-Based Medicine

KW - Female

KW - Germany

KW - Humans

KW - Male

KW - Prevalence

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Tomography, X-Ray Computed

KW - Journal Article

U2 - 10.1055/s-2008-1038931

DO - 10.1055/s-2008-1038931

M3 - Tidsskriftartikel

VL - 146

SP - 595

EP - 601

JO - Zeitschrift fur Orthopadie und Unfallchirurgie

JF - Zeitschrift fur Orthopadie und Unfallchirurgie

SN - 1864-6697

IS - 5

ER -