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

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

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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

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