Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its...
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MDPI AG
2021-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/22/5248 |
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| author | Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi |
| author_facet | Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi |
| author_sort | Naoki Yogo |
| collection | DOAJ |
| description | Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; <i>p</i> = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application. |
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| language | English |
| last_indexed | 2024-03-10T05:24:42Z |
| publishDate | 2021-11-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-6f6bdfe6fed34471ae6d1ce3534169902023-11-22T23:48:34ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011022524810.3390/jcm10225248Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort StudyNaoki Yogo0Chiaki Toida1Takashi Muguruma2Masayasu Gakumazawa3Mafumi Shinohara4Ichiro Takeuchi5Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanDepartment of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanDepartment of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanDepartment of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanDepartment of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanDepartment of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, JapanComputed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; <i>p</i> = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.https://www.mdpi.com/2077-0383/10/22/5248pediatricsemergency departmentclinically important traumatic brain injury |
| spellingShingle | Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study Journal of Clinical Medicine pediatrics emergency department clinically important traumatic brain injury |
| title | Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study |
| title_full | Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study |
| title_fullStr | Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study |
| title_full_unstemmed | Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study |
| title_short | Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study |
| title_sort | simplified clinical decision rule using clinically important events for risk prediction in pediatric head injury a retrospective cohort study |
| topic | pediatrics emergency department clinically important traumatic brain injury |
| url | https://www.mdpi.com/2077-0383/10/22/5248 |
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