Evaluation of closed head injuries using Canadian Scale and New Orleans criteria

Extant literature has been dedicated to the evaluation of closed head injuries using the Canadian Scale and New Orleans criteria for Adult patients in rural areas.The work of Stielle et al. (2005) explored the comparison of the Canadian CT head rule and the New Orleans Criteria in various Patients suffering from minor head injuries. Their work indicated that the current application of computed tomography (CT) for cases of minor head injury is rapidly increasing.This technique is further noted to be inefficient and highly variable in its actual application. The Canadian CT Head Rule (CCHR) as well as New Orleans Criteria (NOC) are clinical decision rules that bwere previously developed in order to guide CT use for the patients suffering from minor head injury while also recording a Glasgow Coma Scale (GCS) scores of between 13-15 for the CCHR as well as a score of 15 on the NOC scale. Stielle et al. (2005) howver noted that there is a great uncertainty regarding the clinical performance of these clinical decision rules.

The objective of Stiell et al.'s (2005) work was to compare the clinical performance of these two critical decision rules for detecting the need for a neurosurgical intervention as well as clinically important brain injury.

The methodology of the paper involve the use of a prospective cohort study as the research design that included a total of nine emergency departments within a large Canadian community as well as university hospitals.In this case, the CCHR were successfully evaluated in a sample comprising of 2707 adults who were presented to the hospitals' emergency departments suffering from blunt head trauma that caused a witnessed loss of consciousness, definite amnesia, disorientation as well as a GCS score of between 13-15. These values CCHR and the NOC were effectively compared in a subgroup made up of 1822 adults suffering from minor head injury as well as a GCS core of fifteen (15).The main outcome measures of this study were the intervention as well as the clinically important brain injury which is evaluated by CT as well as a structured follow-up telephone interview.

The results of this study indicated that out of the 1822 patients having GCS score of fifteen (15), eight (8) which represents 0.4% of the sample required some sort of a neurosurgical intervention while ninety seven has a brain injury which is clinically important.The work of Stielle et al. (2005) concluded that for the patients having minor head injury as well as a GCS score of fifteen (15), the NOC and CCHR have an equivalent/same level of sensitivities for requirement for neurosurgical intervention as well as clinically important brain injury.However, the CCHR has a slightly higher level of specificity for the important clinical outcomes than NOC.Its use would therefore result in a largely reduced rate of imaging.

The work of Smits et al. (2007) explored the guidelines for use of a CT in a multicenter validation study. This is in the context of minor head injury. The purpose of this study was to prospectively as well as externally validate the published national as well as international guidelines for the indications of computed tomography (CT) in the patients with a minor head injury.

In regard to methododology the work of Smits et al. (2007) involved, the study protocol was approved by an institutional review board. All the patients were consented, implicitly to the use of their data for the research purpose. The study was conducted between February 202 and the month of August 2004.The data was collected in a consecutive grouping of adults suffering from a blunt head injury (with a Glasgow Coma Scale of between 13-14 or 15) as well as a risk factor for the neurocranial traumatic complications that are noted at presentation at 4 Dutch university hospitals. The primary outcome was any form of neurocranial traumatic CT finding. The secondary outcomes on the other hand were the clinically relevant traumatic CT findings as well as neurosurgical intervention. The sensitivity as well as specificity of each of the guideline for all the outcomes as well as the number of patients that needed to scan so as to detect a single outcome.

The outcome of the study indicated that out of the 3181 patients, its is only the European

Federation of Neurological Societies guidelines that attained a sensitivity of 100% for all the outcomes. Its specificity was in the range of 0.0-0.5%.The very best specificity for the CT findings as well as neurosurgical interventions were arrived at using the criteria which was proposed by the U.K National Institute for Clinical Excellence. The work of Smits et al. (2007) concluded that all the validated guidelines indicated a trade-off between specificity and sensitivity. The lowest number of patients that are needed to scan for the outcomes was arrived with the NICE criteria.

The work of Stiele at al (2001) explored the Canadian CT Head Rule for patients suffering from minor head injury. This work was done upon the background that there is just too much controversy surrounding the application of computed tomography (CT) for patients suffering from minor head injury.This work was aimed at developing a highly sentitive clinmical decision rule to be used for CT scanning in patients suffering from minor head injuries.