HIGH-YIELD SELECTION CRITERIA FOR CRANIAL COMPUTED-TOMOGRAPHY AFTER ACUTE TRAUMA

Objective: To develop and prospectively evaluate criteria for selectin g head-injured patients requiring cranial CT. Methods: A two-phased pr ospective observational study design was implemented at a university E D. Physicians completed a form with 51 variables for 540 patients in P hase I. Ten high-yield variables were identified and prospectively tes ted on 273 patients in Phase II. Prediction rule performance for ident ification of patients with abnormal CT scans was determined. Results: The combined criteria had a sensitivity of 97% for CT-scan abnormaliti es in Phase I; sensitivity was 96% in Phase II. Negative predictive va lues were 97% and 94%, respectively. Prevalence of disease in Phase I was 17%; prevalence in Phase II was 16%. Had the Phase I criteria been implemented during Phase II, 43 of 273 patients (16%) would not have been scanned, including two patients with positive results who did not require operative intervention. Conclusions: Fifty-one clinical varia bles from head-injured patients were narrowed to ten of statistical si gnificance and consistent interpretation for prospective evaluation. P atients with none of these criteria were found to be at low risk of ha ving sustained significant head injury.