ACEP's Recommendations for Brain Computed Tomography Scan in Adult Minor Head Trauma Patients; a Diagnostic Accuracy Study

Some clinical decision rules have been developed to identify minor head trauma (MHT) patientsin need of brain computed tomography (CT) scan for detection of possible traumatic brain injuries (TBIs). Thisstudy aimed to evaluate the performance of American College of Emergency Physicians (ACEP) recommenda-tions in this regard.

This study is a cross-sectional study of MHT (GCS: 13-15) cases who referred toemergency department of a level one trauma center, Mashhad, Iran, from October 2017 to March 2018. Thescreening performance characteristics of ACEP recommendations for performing brain CT scan in these pa-tients were calculated.

500 patients with a mean age of 37.97±15.96 years were evaluated. Based onlevel one recommendations, 73 (14.6 %) patients had to be assessed by brain CT scan. 67 (91.8%) were assessedand 6 (8.2%) were not assessed based on decision of their in-charge physician. According to level two recom-mendations, 125 (25.0%) patients did not need brain CT scan, 85 (68%) of whom had been assessed (all normal).Performing brain CT scan according to the level one recommendation of ACEP’s clinical policy showed 29.6%sensitivity (95% CI: 13.75 to 50.18) and 86.3% specificity (95% CI: 82.68 to 89.14). The overall ACEP’s clinical pol-icy for neuroimaging of adults with MTBI showed sensitivity and specificity of 92.59% (95% CI: 75.71 to 99.09)and 26.4% (95% CI: 22.51 to 30.65), respectively.

ACEP’s clinical policy has a high-level sensitivityfor using brain CT scan in detection of probable TBI in patients with MHT.