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dc.contributor.authorMarincowitz, Cen
dc.contributor.authorLecky, FEen
dc.contributor.authorAllgar, Ven
dc.contributor.authorHutchinson, Pen
dc.contributor.authorElbeltagi, Hen
dc.contributor.authorJohnson, Fen
dc.contributor.authorQuinn, Een
dc.contributor.authorTarantino, Sen
dc.contributor.authorTownend, Wen
dc.contributor.authorKolias, AGen
dc.contributor.authorSheldon, TAen

International guidelines recommend routine hospital admission for all patients with mild traumatic brain injury (TBI) who have injuries on computed tomography (CT) brain scan. Only a small proportion of these patients require neurosurgical or critical care intervention. We aimed to develop an accurate clinical decision rule to identify low-risk patients safe for discharge from the emergency department (ED) and facilitate earlier referral of those requiring intervention. A retrospective cohort study of case notes of patients admitted with initial Glasgow Coma Scale 13-15 and injuries identified by CT was completed. Data on a primary outcome measure of clinically important deterioration (indicating need for hospital admission) and secondary outcome of neurosurgery, intensive care unit admission, or intubation (indicating need for neurosurgical admission) were collected. Multi-variable logistic regression was used to derive models and a risk score predicting deterioration using routinely reported clinical and radiological candidate variables identified in a systematic review. We compared the performance of this new risk score with the Brain Injury Guideline (BIG) criteria, derived in the United States. A total of 1699 patients were included from three English major trauma centers. A total of 27.7% (95% confidence interval [CI], 25.5-29.9) met the primary and 13.1% (95% CI, 11.6-14.8) met the secondary outcomes of deterioration. The derived clinical decision rule suggests that patients with simple skull fractures or intracranial bleeding <5 mm in diameter who are fully conscious could be safely discharged from the ED. The decision rule achieved a sensitivity of 99.5% (95% CI, 98.1-99.9) and specificity of 7.4% (95% CI, 6.0-9.1) to the primary outcome. The BIG criteria achieved the same sensitivity, but lower specificity (5%). Our empirical models showed good predictive performance and outperformed the BIG criteria. This would potentially allow ED discharge of 1 in 20 patients currently admitted for observation. However, prospective external validation and economic evaluation are required.

dc.format.extent324 - 333en
dc.subjectintracranial hemorrhageen
dc.subjectmild traumatic brain injuryen
dc.subjectminor head injuryen
dc.subjectprognostic modelingen
dc.subjectBrain Concussionen
dc.subjectClinical Decision Rulesen
dc.subjectCohort Studiesen
dc.subjectGlasgow Coma Scaleen
dc.subjectMiddle Ageden
dc.subjectPatient Dischargeen
dc.subjectRetrospective Studiesen
dc.subjectTomography, X-Ray Computeden
dc.titleDevelopment of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study.en
dc.typeJournal Article
plymouth.journalJ Neurotraumaen
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeUnited Statesen
dc.rights.embargoperiodNot knownen
rioxxterms.typeJournal Article/Reviewen

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