No evidence of a clinical decision rule or score to predict radiological deterioration in non-pediatric patients with mild traumatic brain injury and haemorrhage.
Date First Published:
April 12, 2018
Last Updated:
April 12, 2018
Report by:
Émile Fortier and Véronique Paquet, Medical student (Laval University)
Three-Part Question:
In [non-pediatric patients with mild traumatic brain injury and haemorrhage] does a [clinical decision rule or score] exist to predict [radiological deterioration]?
Clinical Scenario:
A 66-years-old man is brought to the emergency department following a fall from his height. He has a score of 14 on the Glasgow Coma Scale and suffers from nausea. An initial Ct Scan is done showing a 4 mm subdural hematoma in the left frontal lobe. The emergency doctor decides to keep him in observation. The patient remains stable during the next eight hours but still complains about nausea. The doctor considers discharging the patient but is aware of case-reports about late clinical deteriorations. He wonders if a clinical decision rule exists to help him assessing the risk for his patient.
Search Strategy:
Pub Med
Mild traumatic brain injur*[Title/Abstract] OR MTBI[Title/Abstract] AND (Heamorrhage[Title/Abstract] OR Hemorrhage[Title/Abstract]) OR Brain Hemorrhage, Traumatic[MeSH Terms] AND (risk[Title/Abstract] OR outcome[Title/Abstract] OR score[Title/Abstract])
Embase
('traumatic brain injury'/exp OR 'mild traumatic brain injury':ab,ti OR mtbi:ab,ti) AND (heamorrhage:ab,ti OR hemorrhage:ab,ti OR 'brain hemorrhage'/exp) AND (score:ab,ti OR outcome:ab,ti OR risk:ab,ti) AND ([adult]/lim OR [aged]/lim OR [middle aged]/lim OR [very elderly]/lim OR [young adult]/lim)
Mild traumatic brain injur*[Title/Abstract] OR MTBI[Title/Abstract] AND (Heamorrhage[Title/Abstract] OR Hemorrhage[Title/Abstract]) OR Brain Hemorrhage, Traumatic[MeSH Terms] AND (risk[Title/Abstract] OR outcome[Title/Abstract] OR score[Title/Abstract])
Embase
('traumatic brain injury'/exp OR 'mild traumatic brain injury':ab,ti OR mtbi:ab,ti) AND (heamorrhage:ab,ti OR hemorrhage:ab,ti OR 'brain hemorrhage'/exp) AND (score:ab,ti OR outcome:ab,ti OR risk:ab,ti) AND ([adult]/lim OR [aged]/lim OR [middle aged]/lim OR [very elderly]/lim OR [young adult]/lim)
Outcome:
911 papers were found of which none were relevant to our question.
Author Commentary:
Despite the absence of relevant articles, we found several papers about neurological deterioration predictors: age > 65, Glasgow Coma Scale (GCS) <15, multiple injuries on initial Ct Scan and hemorrhage volume > 10 mm on initial Ct Scan.
Bottom Line:
There is no evidence of existing clinical score to predict radiological deterioration in non-pediatric patients with mild traumatic brain injury and haemorrhage.