A machine learning based approach for identifying traumatic brain injury patients for whom a head CT scan can be avoided

OBJECTIVE The overuse of head CT examinations has been much discussed, especially those for minor traumatic brain injury (TBI). In the disruptive era, machine learning (ML) is one of the prediction tools that has been used and applied in various fields of neurosurgery. The objective of this study was to compare the predictive performance between ML and a nomogram, which is the other prediction tool for intracranial injury following cranial CT in children with TBI. METHODS Data from 964 pediatric patients with TBI were randomly divided into a training data set (75%) for hyperparameter tuning and supervised learning from 14 clinical parameters, while the remaining data (25%) were used for validation purposes. Moreover, a nomogram was developed from the training data set with similar parameters. Therefore, models from various ML algorithms and the nomogram were built and deployed via web-based application. RESULTS A random forest classifier (RFC) algorithm established the best performance for predicting intracranial injury following cranial CT of the brain. The area under the receiver operating characteristic curve for the performance of RFC algorithms was 0.80, with 0.34 sensitivity, 0.95 specificity, 0.73 positive predictive value, 0.80 negative predictive value, and 0.79 accuracy. CONCLUSIONS The ML algorithms, particularly the RFC, indicated relatively excellent predictive performance that would have the ability to support physicians in balancing the overuse of head CT scans and reducing the treatment costs of pediatric TBI in general practice.

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Does head CT scan pathology predict outcome after mild traumatic brain injury?

European Journal of Neurology ◽

10.1111/j.1468-1331.2012.03813.x ◽

2012 ◽

Vol 20 (1) ◽

pp. 124-129 ◽

Cited By ~ 32

Author(s):

M. Lannsjö ◽

M. Backheden ◽

U. Johansson ◽

J. L. af Geijerstam ◽

J. Borg

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Head Ct

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Repeat Head Computed Tomography in Anticoagulated Traumatic Brain Injury Patients: Still Warranted

The American Surgeon ◽

10.1177/000313481408000123 ◽

2014 ◽

Vol 80 (1) ◽

pp. 43-47 ◽

Cited By ~ 21

Author(s):

Bellal Joseph ◽

Moutamn Sadoun ◽

Hassan Aziz ◽

Andrew Tang ◽

Julie L. Wynne ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Intracranial Hemorrhage ◽

Injury Severity ◽

Head Ct ◽

Lengths Of Stay ◽

Anticoagulation Agents ◽

Head Computed Tomography

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neuro-surgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older ( P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission ( P < 0.001), were more likely to present with an abnormal neurologic examination ( P = 0.004), and had higher hospital and intensive care unit lengths of stay ( P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

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S100B outperforms clinical decision rules for the identification of intracranial injury on head CT scan after mild traumatic brain injury

Brain Injury ◽

10.1080/02699052.2020.1725123 ◽

2020 ◽

Vol 34 (3) ◽

pp. 407-414 ◽

Cited By ~ 1

Author(s):

Courtney Marie Cora Jones ◽

Christopher Harmon ◽

Molly McCann ◽

Holly Gunyan ◽

Jeffrey J. Bazarian

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Decision Rules ◽

Clinical Decision ◽

Intracranial Injury ◽

Clinical Decision Rules ◽

Head Ct

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LO053: Follow-up head CT scan after mild traumatic brain injury: is it really necessary?

CJEM ◽

10.1017/cem.2016.90 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S48-S48

Author(s):

C. Gariepy ◽

M. Émond ◽

N. Le Sage ◽

P. Lavergne ◽

C. Malo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Elderly Patients ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Trauma Center ◽

Antiplatelet Drug ◽

Head Ct ◽

Ct Head

Introduction: Injured seniors visits are on the rise in the emergency department (ED) and up to 30 % are traumatic brain injury (TBI). Many patients suffer from comorbidities that require the use of anticoagulant drugs. The use of these drugs usually modify the trajectory patients will undergo in the ED. In the last decade, some authors suggested a systematic follow-up CT head scan 8 hours after the initial, while others didn’t see the need to scan, referring only to the clinical features. We sought to evaluate the presence of delayed intracranial bleeding, evolution and investigation at the ED of elderly patients presenting for a mild TBI, with or without anticoagulotherapy. Methods: A retrospective cohort was built with hospital administrative clinical data for year 2014 at a Canadian Level 1 trauma center. Patients 65 years and older with traumatic brain injury and residing in the trauma center catching area were included. Data were extracted from medical files using a standardized collection tool in a consecutive pattern. Patients were classified in three groups: use of anticoagulant drug, use of antiplatelet drug and no anticoagulotherapy. Clinico-administrative data, intervention delay, investigations, comorbidities, medication and physiological status were collected. Intra and extra-hospital data were collected for a period of 90 days and the use of imaging and trajectories were analysed. Univariate and multivariate analysis were conducted. Results: 93 of the 189 TBI injury were mild TBI. The 93 patients were divided in patients using anticoagulotherapy (n = 9, 10 %), using antiplatelet drug (n = 58, 62.4 %) and no use of drug (n = 29, 31.2 %). Each group respectively undergo an initial head CT scan in a proportion of 88.9 %, 93 % and 76 %. Follow-up head CT scan were seen in 43 %, 16 % and 10 %. Delayed intra-cranial hemorrhage were identified in respectively 0 %, 2 % and 0 %. Conclusion: With the increase in patients presenting at Canadian ED for head trauma, our study suggests that anticoagulated elderly patients suffering from a mild traumatic brain injury do not systematically require a follow up CT head scan or longer observation time at the ED. A future clinical decision rule to determine the need of follow-up CT could be of benefit to emergency physicians.

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Incidence of delayed bleeding in patients on antiplatelet therapy after mild traumatic brain injury: a systematic review and meta-analysis

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00936-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Giorgio Colombo ◽

Mattia Bonzi ◽

Elisa Fiorelli ◽

Alessandro Jachetti ◽

Viviana Bozzano ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Antiplatelet Therapy ◽

Mild Traumatic Brain Injury ◽

Meta Analysis ◽

Antiplatelet Agent ◽

Secondary Outcome ◽

Head Ct

Abstract Background The scientific evidence regarding the risk of delayed intracranial bleeding (DB) after mild traumatic brain injury (MTBI) in patients administered an antiplatelet agent (APA) is scant and incomplete. In addition, no consensus exists on the utility of a routine repeated head computed tomography (CT) scan in these patients. Objective The aim of this study was to evaluate the risk of DB after MTBI in patients administered an APA. Methods A systematic review and meta-analysis of prospective and retrospective observational studies enrolling adult patients with MTBI administered an APA and who had a second CT scan performed or a clinical follow-up to detect any DB after a first negative head CT scan were conducted. The primary outcome was the risk of DB in MTBI patients administered an APA. The secondary outcome was the risk of clinically relevant DB (defined as any DB leading to neurosurgical intervention or death). Results Sixteen studies comprising 2930 patients were included in this meta-analysis. The pooled absolute risk for DB was 0.77% (95% CI 0.23–1.52%), ranging from 0 to 4%, with substantial heterogeneity (I2 = 61%). The pooled incidence of clinically relevant DB was 0.18%. The subgroup of patients on dual antiplatelet therapy (DAPT) had an increased DB risk, compared to the acetylsalicylic acid (ASA)-only patients (2.64% vs. 0.22%; p = 0.04). Conclusion Our systematic review showed a very low risk of DB in MTBI patients on antiplatelet therapy. We believe that such a low rate of DB could not justify routine repeated CT scans in MTBI patients administered a single APA. We speculate that in the case of clinically stable patients, a repeated head CT scan could be useful for select high-risk patients and for patients on DAPT before discharge.

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Mild Traumatic Brain Injury in Patients on Long-Term Anticoagulation Therapy: Do They Really Need Repeated Head CT Scan?

World Neurosurgery ◽

10.1016/j.wneu.2016.05.061 ◽

2016 ◽

Vol 93 ◽

pp. 100-103 ◽

Cited By ~ 12

Author(s):

Laura Uccella ◽

Cesare Zoia ◽

Francesco Perlasca ◽

Daniele Bongetta ◽

Roberta Codecà ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Anticoagulation Therapy ◽

Head Ct

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Machine Learning for Prediction of Mortality and Unfavorable Outcome in Traumatic Brain Injury: A CENTER-TBI Study

SSRN Electronic Journal ◽

10.2139/ssrn.3441828 ◽

2019 ◽

Author(s):

Benjamin Gravesteijn ◽

Daan Nieboer ◽

Ari Ercole ◽

Hester F. Lingsma ◽

David Nelson ◽

...

Keyword(s):

Machine Learning ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Unfavorable Outcome ◽

Prediction Of Mortality

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Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716990 ◽

2021 ◽

Author(s):

Shrikant Govindrao Palekar ◽

Manish Jaiswal ◽

Mandar Patil ◽

Vijay Malpathak

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Ct Scan ◽

Treatment Protocol ◽

Emergency Setting ◽

Midline Shift ◽

Ct Head ◽

Clinical Tools ◽

Gcs Score

Abstract Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

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