Role of obesity and blood pressure in epicardial adipose tissue thickness in children.

BACKGROUND: Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children. METHODS: A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography. RESULTS: EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001). CONCLUSIONS: This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events. IMPACT: Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

Diagnostic Precision of Anthropometric Variables for the Detection of Hypertension in Children and Adolescents.

Introduction: High blood pressure (HBP) is a health problem the prevalence of which has increased in young populations. Overweight and obesity in early ages have been directly related to its development. Due to the impact of HBP, it is necessary to provide tools that facilitate its early diagnosis, with useful anthropometric variables being those that assess obesity. The objective of this paper was to determine the diagnostic accuracy of anthropometric variables to detect HBP. Methods: A cross-sectional study was conducted on 265 students aged 6-16. The diagnosis of HBP was made following the criteria proposed by the Spanish Association of Pediatrics. Through different statistical methods, the association between anthropometric variables of general obesity with HBP was analyzed. Results: Waist circumference (WC) showed the best diagnostic capacity (area under the receiver operating characteristic curve = 0.729), with a sensitivity and specificity of 72.2% and 76%, respectively, for a cut-off point of 73.5 cm. In the adjusted multivariate analysis, an association was found between HBP and anthropometric variables: WC (odds ratio (OR) = 10.7), body mass index (OR = 7.5), waist-to-height ratio (OR = 5.5) and body fat percentage (OR = 5.3) (p < 0.05). Conclusions: The anthropometric variables studied showed a moderate predictive capacity for HBP, highlighting WC, which showed the strongest association with HBP in the infant and child population.

A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden.

The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10-12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.

Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas / Study of obesity in a rural children population and its relationship with anthropometric variables

Objetivos: Conocer la prevalencia de obesidad en escolares de educación primaria y secundaria, y evaluar la precisión diagnóstica de variables antropométricas para su detección. Diseño: Estudio transversal. Año 2014. Emplazamiento: Área rural de Córdoba. Participantes: Población estudiantil. Se llevó a cabo un muestreo estratificado por edad, género y centros educativos. Un total de 323 alumnos de 6 a 16 años fueron estudiados, cuyos padres habían firmado el consentimiento informado. Mediciones principales: Se determinó la prevalencia de obesidad y se recogieron variables predictoras sociodemográficas, antropométricas, de condición física y alimentación. Se realizó una regresión logística binaria determinando los valores de odds ratio (OR) crudas y ajustadas, se confeccionaron curvas ROC y se determinaron valores de corte, calculando la sensibilidad, la especificidad y el índice de Youden. Resultados: La prevalencia de sobrepeso y obesidad fue del 26,2 y 22,3%, respectivamente. Solo un 15,2% de los escolares realizó dieta mediterránea óptima. El índice cintura-altura (ICT) fue la variable predictiva con mayor OR ajustada (7,1 [4,3-11,6]) y mayor área bajo la curva (0,954 [0,928-0,979]); a partir de un valor de corte global para discriminar obesidad de 0,507, consiguió una sensibilidad del 90% y una especificidad del 87,2%. Conclusiones: La alta prevalencia de obesidad, la media-baja adherencia a la dieta mediterránea y la baja condición física hacen de esta población un objetivo prioritario de actuación para la prevención de futuros eventos cardiovasculares. El ICT ha sido el mejor predictor antropométrico de obesidad, recomendándose su uso para el diagnóstico de obesidad en población infantil en detrimento del índice de masa corporal

Goals: To know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. Design: Cross-sectional study. Location: Rural area of Córdoba. In the year 2014. Participants: Student population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. Main measurements: The prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. Results: The prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. Conclusions: The high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index

[Study of obesity in a rural children population and its relationship with anthropometric variables]. / Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas.

GOALS: To know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. DESIGN: Cross-sectional study. LOCATION: Rural area of Córdoba. In the year 2014. PARTICIPANTS: Student population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. MAIN MEASUREMENTS: The prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. RESULTS: The prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. CONCLUSIONS: The high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index.

Influencia de las condiciones de trabajo sobre la incapacidad temporal por contingencias comunes / Influence of the working conditions on sickness absence due to common diseases

OBJETIVOS: Estimar la importancia del ambiente de trabajo en las bajas laborales y mostrar posibles relaciones con variables clínico-laborales. DISEÑO: Se realizó un estudio observacional descriptivo. Emplazamiento: Inspección médica de una provincia andaluza. PARTICIPANTES: Mil dieciséis trabajadores en situación de incapacidad temporal (IT) por contingencias comunes. Mediciones principales: Mediante encuesta autocumplimentada se recogieron datos demográficos, profesión, actividad, evaluación de riesgos y causa laboral percibida, que voluntariamente prestaron su consentimiento cuando eran revisados durante 2015; además se comprobaron los procesos que causaron IT en su historia clínica digital. Utilizando criterios aplicados por expertos se valoró el papel de las condiciones de trabajo en cada episodio de IT. Se llevaron a cabo análisis bivariante y multivariante para comprobar relaciones entre las variables. RESULTADOS: En un 17,1% de los procesos encontramos relación con ambiente de trabajo inadecuado. Las actividades sanitaria y de hostelería presentan asociación significativa con las condiciones de trabajo como causa de la baja laboral (p < 0,001). Con respecto al diagnóstico, los trastornos ansioso depresivos (p < 0,01) y las lumbalgias (p < 0,05) están asociados con las condiciones de trabajo. Los factores que relacionan baja laboral y ambiente de trabajo son: lugar de residencia (OR = 0,34; 0,21-0,6), nivel de estudios medios/superiores (OR = 1,7 1,2-2,4), contrato fijo (OR = 2,0; 1,3-3,1), empresas grandes (OR = 1,97; 1,3-2,9) y puesto de trabajo evaluado (OR = 2,7; 1,6-3,2). CONCLUSIONES: La IT se ve afectada por factores relacionados con el ambiente de trabajo. Actuaciones preventivas específicas para los trabajadores en su lugar de trabajo podrían disminuir las bajas de origen laboral calificadas como contingencia común

OBJECTIVE: To estimate the importance of the working environment in sickness absence, as well as to show possible relationships with clinical-work variables. DESIGN: A descriptive observational study. Site: Medical Inspection of an Andalusian province. PARTICIPANTS: A total of 1016 workers on certified sick leave due to a common illness. MAIN MEASUREMENTS: A self-report questionnaire was used to collect demographic data, profession, activity, risk assessment, and perceived occupational cause, on patients who voluntarily gave their consent when they were reviewed during 2015. The illness that caused certified sickness absences was verified in the computerised medical records. Using criteria applied by experts, the role of working conditions in each episode of certified sick leave was assessed. Bivariate and multivariate analyses were performed to determine any relationships between the variables. RESULTS: An inadequate work environment was found in 17.1% of the sickness processes. Health and hospitality services activities have a significant association with working conditions as a cause of sick leave (P < .001). With respect to diagnosis, anxiety-depressive disorders (P < .01) and low back pain (P < .05) were associated with working conditions. The factors related to certified sickness absence and work environment were: residence (OR = 0.34, 0.21-0.6), normal/higher education (OR = 1.7, 1.2-2.4), (OR = 2.0 1.3-3.1), large companies (OR = 1.97, 1.3-2.9), and job (OR = 2.7, 1.6-3, 2). CONCLUSIONS: sickness absence is affected by factors related to the work environment. Specific preventive actions for workers at their workplace could reduce work related diseases classified as a common illness

Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with a normal computed tomography scans. / Cefalea súbita, punción lumbar y diagnóstico de hemorragia subaracnoidea en pacientes con una tomografía computarizada normal.

OBJECTIVES: To assess the usefulness of computed tomography (CT) to identify subarachnoid bleeding in patients with neurologic deficits seeking emergency care for sudden headache within 6 hours of onset of symptoms. MATERIAL AND METHODS: Retrospective observational study of patients presenting with sudden nontraumatic headache peaking during the previous hour in the absence of neurologic deficits. We ordered CT scans for all patients, and if the scan was normal we performed a lumbar puncture. All patients were then followed for 6 months. RESULTS: Eighty-five patients were included. Subarachnoid bleeding was identified in 10 (10.2%) patients by CT. Seventy- four lumbar punctures were performed in patients with negative CTs; the lumbar puncture was positive in 1 patient and inconclusive in 2 patients. In all 3 patients, bleeding was ruled out with later images; thus, no cases of subarachnoid hemorrhage were confirmed in the 74 patients who underwent lumbar puncture. Nor were any cases found in any of these patients during follow-up. CONCLUSION: A CT scan taken within 6 hours of onset of sudden headache is sufficient for confirming or ruling out subarachnoid bleeding in patients with sudden headache who have no neurologic deficits.

OBJETIVO: Valorar la utilidad de la tomografía computarizada (TC) para identificar la hemorragia subaracnoidea (HSA) en pacientes que consultan en el servicio de urgencias por cefalea súbita sin déficit neurológico dentro de las seis primeras horas desde el comienzo de los síntomas. METODO: Estudio observacional, retrospectivo, de pacientes que consultaron por cefalea súbita, no traumática, con un pico de máxima intensidad dentro de la hora previa y sin déficit neurológico. A todos los pacientes se les realizó una TC seguida de una punción lumbar (PL) si la TC era normal, y seguimiento a los 6 meses. RESULTADOS: Se incluyeron 85 pacientes. Se diagnosticaron 10 (10,2%) casos de HSA en la TC, y se realizaron 74 PL, en pacientes con una TC negativa, de las que una fue positiva y dos no concluyentes, pero en estudios posteriores de imagen se descartó la HSA. En total, la PL en 74 pacientes con TC normal no confirmó ningún caso de HSA. Tampoco se confirmó ningún caso durante el seguimiento. CONCLUSIONES: En los pacientes con cefalea súbita y sospecha de HSA, sin inconsciencia ni focalidad neurológica, una TC de alta resolución realizada en las primeras 6 horas desde la aparición de la cefalea fue suficiente para confirmar o descartar ese diagnóstico.

Cefalea súbita, punción lumbar y diagnóstico de hemorragia subaracnoidea en pacientes con una tomografía computarizada normal / Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with a normal computed tomography scans

Objetivo. Valorar la utilidad de la tomografía computarizada (TC) para identificar la hemorragia subaracnoidea (HSA) en pacientes que consultan en el servicio de urgencias por cefalea súbita sin déficit neurológico dentro de las seis primeras horas desde el comienzo de los síntomas. Método. Estudio observacional, retrospectivo, de pacientes que consultaron por cefalea súbita, no traumática, con un pico de máxima intensidad dentro de la hora previa y sin déficit neurológico. A todos los pacientes se les realizó una TC seguida de una punción lumbar (PL) si la TC era normal, y seguimiento a los 6 meses. Resultados. Se incluyeron 85 pacientes. Se diagnosticaron 10 (10,2%) casos de HSA en la TC, y se realizaron 74 PL, en pacientes con una TC negativa, de las que una fue positiva y dos no concluyentes, pero en estudios posteriores de imagen se descartó la HSA. En total, la PL en 74 pacientes con TC normal no confirmó ningún caso de HSA. Tampoco se confirmó ningún caso durante el seguimiento. Conclusiones. En los pacientes con cefalea súbita y sospecha de HSA, sin inconsciencia ni focalidad neurológica, una TC de alta resolución realizada en las primeras 6 horas desde la aparición de la cefalea fue suficiente para confirmar o descartar ese diagnóstico (AU)

Objective. To assess the usefulness of computed tomography (CT) to identify subarachnoid bleeding in patients with neurologic deficits seeking emergency care for sudden headache within 6 hours of onset of symptoms. Methods. Retrospective observational study of patients presenting with sudden nontraumatic headache peaking during the previous hour in the absence of neurologic deficits. We ordered CT scans for all patients, and if the scan was normal we performed a lumbar puncture. All patients were then followed for 6 months. Results. Eighty-five patients were included. Subarachnoid bleeding was identified in 10 (10.2%) patients by CT. Seventy-four lumbar punctures were performed in patients with negative CTs; the lumbar puncture was positive in 1 patient and inconclusive in 2 patients. In all 3 patients, bleeding was ruled out with later images; thus, no cases of subarachnoid hemorrhage were confirmed in the 74 patients who underwent lumbar puncture. Nor were any cases found in any of these patients during follow-up. Conclusions. A CT scan taken within 6 hours of onset of sudden headache is sufficient for confirming or ruling out subarachnoid bleeding in patients with sudden headache who have no neurologic déficits (AU)

Catastrophic antiphospholipid antibody syndrome presenting as acute vascular occlusion in a young female patient / Síndrome de anticuerpos antifosfolípidos catastrófico que se presenta con oclusión vascular aguda en una paciente joven

Acquired thrombotic and thromboembolic disorders may be presented initially with symptoms and signs of acute ischaemia or organ dysfunction that will lead many of these patients to seek care in the emergency department. We report a case of a 19-year-old female patient who developed catastrophic antiphospholipid syndrome (CAPS syndrome or Asherson syndrome) 6 weeks post stillbirth with an initial presentation of acute vascular occlusion. The patient was immediately operated and anticoagulated with significant improvement (AU)

Los trastornos trombóticos y tromboembólicos adquiridos pueden manifestarse inicialmente con signos y síntomas de isquemia aguda o disfunción orgánica que derivará a muchos de estos pacientes al servicio de urgencias. Se presenta el caso de una paciente de 19 años de edad que desarrolló un síndrome antifosfolípido catastrófico (o síndrome de Asherson) 6 semanas después del parto de un feto muerto con una presentación inicial de oclusión vascular aguda. La paciente fue intervenida inmediatamente y se inició un tratamiento con anticoagulantes que supuso una mejora significativa (AU)

[Influence of the working conditions on sickness absence due to common diseases]. / Influencia de las condiciones de trabajo sobre la incapacidad temporal por contingencias comunes.

OBJECTIVE: To estimate the importance of the working environment in sickness absence, as well as to show possible relationships with clinical-work variables. DESIGN: A descriptive observational study. SITE: Medical Inspection of an Andalusian province. PARTICIPANTS: A total of 1016 workers on certified sick leave due to a common illness. MAIN MEASUREMENTS: A self-report questionnaire was used to collect demographic data, profession, activity, risk assessment, and perceived occupational cause, on patients who voluntarily gave their consent when they were reviewed during 2015. The illness that caused certified sickness absences was verified in the computerised medical records. Using criteria applied by experts, the role of working conditions in each episode of certified sick leave was assessed. Bivariate and multivariate analyses were performed to determine any relationships between the variables. RESULTS: An inadequate work environment was found in 17.1% of the sickness processes. Health and hospitality services activities have a significant association with working conditions as a cause of sick leave (P<.001). With respect to diagnosis, anxiety-depressive disorders (P<.01) and low back pain (P<.05) were associated with working conditions. The factors related to certified sickness absence and work environment were: residence (OR=0.34, 0.21-0.6), normal/higher education (OR=1.7, 1.2-2.4), (OR=2.0 1.3-3.1), large companies (OR=1.97, 1.3-2.9), and job (OR=2.7, 1.6-3, 2). CONCLUSIONS: Sickness absence is affected by factors related to the work environment. Specific preventive actions for workers at their workplace could reduce work related diseases classified as a common illness.

Comparación de la regla canadiense y los criterios de New Orleans en el traumatismo craneal leve en un hospital español / Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury in a Spanish hospital

Fundamento y objetivo: Comparar 2 escalas para la valoración de pacientes con traumatismo craneoencefálico (TCE) leve, la regla canadiense (EC) y los criterios de New Orleans (NO), de acuerdo a su precisión diagnóstica, en pacientes que acuden a un servicio de urgencias hospitalario, así como determinar los valores predictivos más importantes. Método: Estudio transversal realizado en un hospital de primer nivel en el periodo de enero del 2011 a enero del 2013. Se incluyeron los pacientes con criterios de TCE leve. A todos los pacientes se les realizó una tomografía computarizada (TC) de cráneo como parte del protocolo interno y se completó con la EC y los criterios de NO. Consideramos como variable principal la presencia de lesiones traumáticas en el TC, y como variables secundarias la intervención neuroquirúrgica y el síndrome posconmocional. Se compararon la sensibilidad, especificidad, los valores predictivos y el índice de validez (IV) de la EC y de los criterios de NO en el subgrupo de pacientes con una puntuación en la escala de coma de Glasgow (GCS) de 15 puntos. Resultados: Se evaluaron un total de 217 pacientes, de los que 197 presentaban una puntuación en la GCS de 15 puntos. Ambas escalas mostraban un 100% de sensibilidad cuando se presentaba una lesión importante en el TC, la EC 100% (IC 95%: 97,4-100%) y los criterios de NO 100% (IC 95%: 97,4-100%), pero la EC consiguió mayores valores de especificidad 25,3% (IC 95%: 18,6-32%), valor predictivo positivo (VPP) e IV. Las 2 escalas mostraron un 100% de sensibilidad en relación con la intervención neuroquirúrgica, y la EC con criterios de alto riesgo consiguió, claramente, una mayor especificidad, VPP e IV de 55,2 (IC 95%: 8,3-62,2%) vs. 7,6 (IC 95%: 3,8-11,5%) de NO. Con respecto al síndrome posconmocional, los criterios de NO mostraron mayor sensibilidad 100% (IC 95%: 96,2-100%) y valores predictivos, aunque menor especificidad e IV comparado con la EC 76,9% (IC 95%: 50,2-100%). Conclusiones: Nuestro estudio demuestra la alta sensibilidad de la EC y de los criterios de NO en pacientes con TCE leve tanto para detectar una lesión clínica importante en el TC como la necesidad de una intervención neuroquirúrgica, así como una mejor especificidad de la EC comparada con los criterios de NO. Se recomienda la adopción de reglas de predicción clínica, en especial de la EC, para la solicitud de un TC de cráneo en pacientes con TCE leve (AU)

Background and objective: To compare two scales for assessment of patients with mild head injury. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) according to their diagnostic accuracy in patients attending an emergency department, and to determine the most important predictive values. Method: Cross-sectional study in a first-level Hospital in the period of January 2011 to January 2013. Patients with mild head injury criteria were included. All the patients underwent a computed tomography (CT) of the head as part of internal protocol and the CCHR and NOC criteria were recorded for each patient. We consider the main variable the presence of traumatic lesions on CT and, as secondary variables, neurosurgical intervention and post-concussion syndrome. Sensitivity, specificity, predictive values and validity index (VI) of the CCHR and the NO criteria in the subgroup of patients with a Glasgow Coma Scale (GCS) score of 15 points were compared. Results: A total of 217 patients, of whom 197 had a GCS score of 15 points were evaluated. Both rules showed 100% sensitivity when a significant injury was presented in the CT, the CCHR 100% (95% CI: 97.4%-100%) and the NO criteria 100% (95% CI: 97.4%-100%); but the CCHR achieved higher values of specificity 25.3% (95% CI: 18.6%-32%), positive predictive value (PPV) and VI. The two rules showed a 100% sensitivity regarding neurosurgical intervention; however the CCHR with high-risk criteria showed better specificity, PPV and VI 55.2 (95% CI: 8.3%-62.2%) compared to the NO criteria 7.6 (95% CI: 3.8%-11.5%). With regard to post-concussion syndrome criteria NO criteria showed better sensitivity 100% (95% CI: 96.2%-100%) and predictive values, but lower specificity and VI compared with the CCHR 76.9% (95% CI: 50.2%-100%). Conclusions: Our study demonstrates the high sensitivity of the CCHR and the NO criteria in patients with mild head injury, both to detect a significant clinical lesion on CT or the need for neurosurgical intervention and better specificity of CCHR compared with NO criteria. The adoption of clinical prediction rules, especially the CCHR, to request a CT scan in patients with mild head injury should be recommended in the emergency department (AU)

Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury in a Spanish hospital. / Comparación de la regla canadiense y los criterios de New Orleans en el traumatismo craneal leve en un hospital español.

BACKGROUND AND OBJECTIVE: To compare two scales for assessment of patients with mild head injury. The Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) according to their diagnostic accuracy in patients attending an emergency department, and to determine the most important predictive values. METHOD: Cross-sectional study in a first-level Hospital in the period of January 2011 to January 2013. Patients with mild head injury criteria were included. All the patients underwent a computed tomography (CT) of the head as part of internal protocol and the CCHR and NOC criteria were recorded for each patient. We consider the main variable the presence of traumatic lesions on CT and, as secondary variables, neurosurgical intervention and post-concussion syndrome. Sensitivity, specificity, predictive values and validity index (VI) of the CCHR and the NO criteria in the subgroup of patients with a Glasgow Coma Scale (GCS) score of 15 points were compared. RESULTS: A total of 217 patients, of whom 197 had a GCS score of 15 points were evaluated. Both rules showed 100% sensitivity when a significant injury was presented in the CT, the CCHR 100% (95% CI: 97.4%-100%) and the NO criteria 100% (95% CI: 97.4%-100%); but the CCHR achieved higher values of specificity 25.3% (95% CI: 18.6%-32%), positive predictive value (PPV) and VI. The two rules showed a 100% sensitivity regarding neurosurgical intervention; however the CCHR with high-risk criteria showed better specificity, PPV and VI 55.2 (95% CI: 8.3%-62.2%) compared to the NO criteria 7.6 (95% CI: 3.8%-11.5%). With regard to post-concussion syndrome criteria NO criteria showed better sensitivity 100% (95% CI: 96.2%-100%) and predictive values, but lower specificity and VI compared with the CCHR 76.9% (95% CI: 50.2%-100%). CONCLUSIONS: Our study demonstrates the high sensitivity of the CCHR and the NO criteria in patients with mild head injury, both to detect a significant clinical lesion on CT or the need for neurosurgical intervention and better specificity of CCHR compared with NO criteria. The adoption of clinical prediction rules, especially the CCHR, to request a CT scan in patients with mild head injury should be recommended in the emergency department.