Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

doi:10.5847/wjem.j.1920-8642.2023.042

World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (3): 227-230.doi: 10.5847/wjem.j.1920-8642.2023.042

Special Issue: Trauma

• Research Letters • Previous Articles Next Articles

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury Open Access

Kasamon Aramvanitch, Korawee Khachornwattanakul, Piraya Vichiensanth(), Chetsadakon Jenpanitpong, Ponlawat Kanchayawong, Sorawich Watcharakitpaisan, Chaiyaporn Yuksen

Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand

Received:2022-11-06 Online:2023-04-28 Published:2023-05-01
Contact: Piraya Vichiensanth E-mail:Piraya.vic@mahidol.edu

1. Supplementary files.pdf(190KB)

Abstract

Kasamon Aramvanitch, Korawee Khachornwattanakul, Piraya Vichiensanth, Chetsadakon Jenpanitpong, Ponlawat Kanchayawong, Sorawich Watcharakitpaisan, Chaiyaporn Yuksen. Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury[J]. World Journal of Emergency Medicine, 2023, 14(3): 227-230.

Figures/Tables 3

Table 1.

Table 2.

Table 3.

References 15

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Age cut-offs	Sensitivity, %	Specificity, %	Missed TBI, n (%)	AUROC (95% CI)
≥65 years	95.2	8.9	3 (4.8)	0.52 (0.49-0.55)
≥70 years	81.0	25.5	12 (19.1)	0.53 (0.48-0.58)
≥75 years	57.1	39.8	27 (42.9)	0.48 (0.42-0.55)
≥80 years	38.1	60.0	39 (61.9)	0.49 (0.43-0.55)
≥85 years	20.6	78.1	50 (79.4)	0.49 (0.44-0.55)

Clinical factors	Brain-positive CT (n=63)	Brain-negative CT (n=643)	P-value	AUROC (95% CI)
Age ≥65 years	60 (95.3)	586 (91.1)	0.347	0.52 (0.49-0.55)
Age ≥70 years	51 (81.0)	479 (74.5)	0.289	0.53 (0.48-0.58)
Canadian CT Head Rule
Only age ≥65 years Age with other positive criteria	26 (41.3) 37 (58.8)	87 (13.6) 556 (86.5)	<0.001	0.64 (0.58-0.70)
GCS score <15 at 2 h after injury	3 (4.8)	0 (0.0)	<0.001	0.52 (0.50-0.55)
Any signs of basal skull fracture	1 (1.6)	3 (0.5)	0.313	0.51 (0.49-0.52)
Suspected open or depressed skull fracture	0 (0.0)	2 (0.3)	1.000	0.50 (0.50-0.50)
Vomiting ≥2 episodes	7 (11.1)	18 (2.8)	0.004	0.54 (0.50-0.58)
Amnesia before impact of ≥30 min	18 (28.6)	53 (8.3)	<0.001	0.60 (0.54-0.66)
Dangerous mechanism	6 (9.6)	23 (3.6)	0.037	0.53 (0.49-0.57)
Other clinical factors
Loss of consciousness >5 min	13 (20.7)	46 (7.2)	<0.001	0.57 (0.52-0.62)
Intoxication	0 (0.0)	6 (0.9)	1.000	0.50 (0.49-0.50)
Headache	6 (9.6)	20 (3.2)	0.022	0.53 (0.49-0.57)
Use of antiplatelet medication	23 (36.6)	155 (24.1)	0.034	0.56 (0.60-0.62)

Models	AUROC	95% CI	P-value
CCHR	0.66	0.60-0.73	<0.001
Modified CCHR with age ≥70 years	0.68	0.61-0.75	<0.001
New model^* with age ≥65 years	0.71	0.64-0.78	<0.001
New model^* with age ≥70 years	0.72	0.65-0.78	<0.001

Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury Open Access

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