1 Comparision of NexusII,New Orleans and Canada cranial CT rules in Head Trauma Patients: A retrospective study.

Abstract : During recent years the usage of CT in EDs has increased greater than before. Although there is a consensus to scan patients with moderate or severe head trauma urgently, an ongoing debate continues as to which patients with mild head injury should be scanned.In our study we aimed to compare the CCHR, NOC, and NEXUS-II rules to identify the clinically significant brain injuries. Acute mild head injury was defined as a closed head injury by blunt force within 24 hours, with a Glasgow Coma Scale (GCS) score of 13 to 15. All patients who visited our ER with minor head trauma were enrolled in study prospectively, and all CCHR, NOC, and NEXUS rules were evaluated separately for each patient. The determined outcome lesions were subarachnoid haemorrhage, subdural hematoma, contusion, epidural hematoma, skull fracture, intraparenchymal haemorrhage, and cerebral oedema.The sensitivity, specificity, and predictive values with 95% confidence intervals (CIs) for the performance of each rule for CT scan and each criterion of rules and all symptoms predicted to be caused by head trauma were calculated. P < 0.05 was considered statistically significant. RESULTS: A total of 140 patients were included in the study. The mean age of the patients included in the study was 55.59 ± 23.258 (median 57.00)years . Of all patients, 62.1% (n: 87) were male and 37.9% (n: 53) were female. In terms of gender, it was found that men had more minor head trauma. The mean age of male patients was 49.90 and 64.94 for female patients. Among whole study population, 43.57% (n = 61) of the patients were 65 years and older. Sensitivity, specificity, and positive predictive value negative predictive value of NOC were 87.5%, 6.57%, 44.09% and 38.46%, respectively. The sensitivity of CCHR rule was 82.81%, its specificity was 32.8%, its positive predictive value was 50.96%, and its negative predictive value was 69.4%. The sensitivity of NEXUS II rule was 93.75%, specificity was 3.94%, positive predictive value was 45.11%, and the negative predictive value was 42.85% Additional studies may be demonstrated by focusing specifically on the sensitivity and specificity of each criterion separately. Additionally, more studies should be performed especially in geriatric population to specify a criterion for each rule separately.

Keyword : Head Trauma, CT rules, EmergencyMedicine