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Abstract：
The primary aim was to evaluate the compliance of cranial CT indication with the national guideline-based decision rules in patients after mTBI. The secondary aim was to determine the incidence of CT pathologies among justified and unjustified CT scans and to investigate the diagnostic value of these decision rules. This is a retrospective, single-center study on 1837 patients (mean age = 70.7 years) referred to a clinic of oral and maxillofacial surgery following mTBI over a five-year period. The current national clinical decision rules and recommendations for mTBI were retrospectively applied to calculate the incidence of unjustified CT imaging. The intracranial pathologies among the justified and unjustified CT scans were presented using descriptive statistical analysis. The performance of the decision rules was ascertained by calculating the sensitivity, specificity, and predictive values. A total of 123 intracerebral lesions were radiologically detected in 102 (5.5%) of the study patients. Most (62.1%) of the CT scans strictly complied with the guideline recommendations, and 37.8% were not justified and likely avoidable. A significantly higher incidence of intracranial pathology was observed in patients with justified CT scans compared with patients with unjustified CT scans (7.9% vs. 2.5%, p < 0.0001). Patients with loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of cranial fractures presented pathologic CT findings more frequently (p < 0.05). The decision rules identified CT pathologies with 92.28% sensitivity and 39.08% specificity. To conclude, compliance with the national decision rules for mTBI was low, and more than a third of the CT scans performed were identified as \"likely avoidable\". A higher incidence of pathologic CT findings was detected in patients with justified cranial CT imaging. The investigated decision rules showed a high sensitivity but low specificity for predicting CT pathologies.
摘要：
主要目的是评估mTBI后患者的头颅CT适应症与基于国家指南的决策规则的依从性。次要目的是确定合理和不合理的CT扫描中CT病理的发生率，并研究这些决策规则的诊断价值。这是一个回顾展,单中心研究纳入1837例患者(平均年龄=70.7岁),转诊至mTBI后口腔颌面外科的诊所,为期5年.对mTBI的当前国家临床决策规则和建议进行回顾性应用，以计算不合理的CT成像的发生率。使用描述性统计分析呈现了合理和不合理的CT扫描中的颅内病理。通过计算灵敏度来确定决策规则的性能，特异性，和预测值。在102名（5.5％）的研究患者中，放射学共检测到123个脑内病变。大多数（62.1％）的CT扫描严格遵守指南建议，37.8%是不合理的，可能是可以避免的。与进行CT扫描的患者相比，进行CT扫描的患者的颅内病理发生率明显更高（7.9％vs.2.5%,p<0.0001)。失去意识的病人,健忘症,癫痫发作,头痛,嗜睡,头晕,恶心,颅骨骨折的临床征象更频繁地表现为病理性CT表现(p<0.05)。决策规则以92.28%的灵敏度和39.08%的特异性识别CT病理。最后，对mTBI国家决策规则的遵守程度很低，超过三分之一的CT扫描被确定为“可能可以避免”。在具有合理的颅骨CT成像的患者中，病理CT发现的发生率更高。研究的决策规则显示出预测CT病理的高灵敏度但低特异性。
