Adapting the Canadian CT head rule age criteria for mild traumatic brain injury

OBJECTIVE

With the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.

METHODS

We conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardised. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75 and 80 years old.

RESULTS

104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% CI) of the CCHR were 100% (89.1 to 100) and 4.2% (0.9 to 11.7) for a modified criteria of 70 years old; 100% (89.1 to 100) and 13.9% (6.9 to 24.1) for 75 years old; and 90.6% (75.0 to 98.0) and 23.6% (14.4 to 35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n=10/41) among the individuals aged 65-74 without missing CIBI.

CONCLUSION

Adjusting the age criteria of the Canadian CT head rule to 75 years old could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.

[Not Available]

The rate of non-compliance with the post-vasectomy semen examination procedure at the Centre Hospitalier de l'Université Laval (CHUL) between October 1, 1985 and March 31, 1987 was 21%, one of the highest in the literature. The purpose of our study was to determine the causes of this situation. The socio-demographic profile obtained from the computerized files of 50 patients who did not comply with the procedure was comparable to that of the 183 patients who did comply. A telephone survey of 43 non-compliant patients was carried out. In 70% of the responses to an open question on the reasons for non-compliance, the subject cited on his own negligence. In response to the closed questions, the constraints involved in the semen examination procedure were cited most often (49%). In the responses to both open and closed questions, a lack of information was cited least often. There is not a distinctive profile among vasectomy patients at the CHUL that would make it possible to predict compliance. Despite the fact that it would be difficult to improve the factors associated with patient negligence, it might be possible to increase compliance by following up more closely and lessening the constraints.