Using Canadian CT head rule in a developing nation: Validation and comparing utilisation by emergency physicians and neurosurgeons

Objective: The objective of this study was to test the validity of the Canadian CT Head rule (CCHR) in cases of minor traumatic brain injury (TBI) in an Indian emergency department (ED). A secondary objective was to compare of the patterns of neuroradiology references between the emergency physician (EP) and the neurosurgeon. Methods: The study was prospectively conducted between July 2019 and July 2020. Patients satisfying the inclusion criteria were subjected to CCHR and the result was documented. The neurosurgeon was consulted for the final decision. In case of disagreement between the neurosurgeon and the EP, the decision of neuro-radiology was taken by the neurosurgeon. Results: A total of 101 patients satisfied the inclusion criteria. 62 subjects fulfilled the CCHR. Out of 62 subjects who fulfilled the CCHR criteria, 46 (74.1%) were reported to have normal CT scans, while 16 had either haemorrhages (n = 12) or contusions (n = 4). All the subjects who didn't fulfil the CCHR (n = 39), were reported to have normal CT scans. The EPs used CCHR in all cases of mild TBI while the neurosurgeons chose to get CT brains in all the subjects based of clinical gestalt. CCHR had an observed sensitivity of 100% and specificity of 45.8%. Conclusion: The CCHR has 100% sensitivity as a screening tool for patients requiring CT brains in case of TBI though the specificity is found to be rather low (45.8%). EPs show a higher level of awareness and inclination to use CDRs in cases of minor TBI to direct the decision for neuro-radiology, in comparison to neurosurgeons. ED residents reported comfort in mobile application based usage of the rule. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

The study tested the validity of the Canadian CT Head rule (CCHR) for minor traumatic brain injury (TBI) cases in an Indian emergency department, showing a high sensitivity but low specificity. Emergency physicians showed a greater awareness and inclination to use CDRs compared to neurosurgeons in cases of minor TBI to guide decisions for neuro-radiology.