Canadian CT Head Rules Superior to New Orleans Criteria in Predicting Neurosurgical Intervention

In a head-to-head competition between the New Orleans Criteria and the Canadian Computed tomography (CT) Head Rules, the Canadian rules demonstrated higher sensitivity and specificity in predicting neurosurgical intervention for mild head injury.

The results of the study, conducted in Tunisia, were published online August 21, 2012, in the journal Annals of Emergency Medicine. “Although clinical decision rules may not perform exactly the same way in all populations, our study suggests that, at least in Tunisia, emergency physicians should use the Canadian CT Head Rule in their routine clinical practice for patients with mild head injury,” said lead study author Semir Nouira, MD, from Fattouma Bourguiba University Hospital (Monastir, Tunisia). “Application of the Canadian rule could potentially lead to reductions in CT scans for mild head injury, one of the most common injuries seen in emergency departments.”

Researchers examined medical records for 1,592 patients with mild traumatic brain injury. Patients were chiefly evaluated on the need for neurosurgical intervention and the evidence of traumatic lesions on head CT scan. Sensitivity was 100% and specificity was 60% on the need for neurosurgical intervention for the Canadian CT Head Rules (CCHR). Sensitivity was 82% and specificity was 26% on the necessity for neurosurgical intervention for the New Orleans Criteria (NOC). Sensitivity and specificity on clinically significant head CT findings were 95% and 65% for CCHR and 86% and 28% for NOC.

“There is still debate over whether these decision rules could be applied worldwide because they haven’t been validated across populations with different demographics and ethnic characteristics,” said Dr. Nouira. “Therefore, more research is warranted to clearly establish the benefit of the Canadian rule in real life clinical practice.”