Akut vurdering og håndtering af hovedtraumer

Adskillelige kliniske retningslinjer for akut vurdering og håndtering af hovedtraumer understøtter hospitalspersonalet med evidensbaserede anbefalinger ud fra sværhedsgraden af hovedtraumet og risikofaktorer for indsatskrævende intrakranielle blødninger.

Skandinavisk Neurotraume Komité (SNC) udarbejdede i 2013 og 2015 to kliniske retningslinjer for undersøgelse og håndtering af hhv. voksne (>18 år) og børn og unge (<18 år) med hovedtraume inden for de første 24 timer. Retningslinjerne hjælper med at afgøre behovet for CT-skanning, observation, S100B-prøve eller udskrivelse med instruktioner. Den er baseret på systematiske reviews og evidensvurdering (CEBM, QUADAS, GRADE samt Delphi-proces).

Inddeling efter risiko for at finde fund ved strukturel billedskanning.

I retningslinjerne klassificeres hovedtraumer efter Head Injury Severity Scale (HISS) og stratificeres i minimal, lav, moderat eller høj risiko for intrakranielle fund bed strukturel billedskanning. Validering i en kohorte på 662 patienter viste 97% sensitivitet og 34% specificitet for intrakraniel hæmoragi på CT. En konsekvent anvendelse af retningslinjen kan reducere CT-skanninger med ca. 32%.

Internationale retningslinjer^1-11

Aldersgruppe	Retningslinje		Link
Voksne	NICE – 2023	National Institute for Health and Care excellence	https://www.nice.org.uk/guidance/ng232
	CHIP – 2022	Updated CT in Head Injury Patients Rule (Netherlands)	https://doi.org/10.1016/j.injury.2022.07.001
	SNC – 2013	Scandinavian Neurotrauma Committee	https://doi.org/10.1186/1741-7015-11-50
	NEXUS II – 2005	The National Emergency-Radiography Utilization Study II	https://doi.org/10.1097/01.ta.0000187813.79047.42
	CCHR – 2001	Canadian CT Head Rule	https://doi.org/10.1016/S0140-6736(00)04561-X
	NOC – 2000	New Orleans Criteria	https://doi.org/10.1056/NEJM200007133430204
Børn	NICE – 2023	National Institute for Health and Care excellence	https://www.nice.org.uk/guidance/ng232
	French PECARN 2016	Head Trauma Decision Rule (based on PECARN rule)	https://doi.org/10.1186/s13049-016-0287-3
	SNC – 2016	Scandinavian Neurotrauma Committee	https://doi.org/10.1186/s12916-016-0574-x
	CATCH – 2010	Canadian Assessment of Tomography for Childhood Head injury	https://pubmed.ncbi.nlm.nih.gov/20142371/
	PECARN – 2009	Pediatric Emergency Care Applied Research Network traumatic brain injury (TBI) algorithm in ED for head CT decision-making in pediatric patients	https://doi.org/10.1016/S0140-6736(09)61558-0
	CHALICE – 2006	Children’s head injury algorithm for the prediction of important clinical events (England)	https://doi.org/10.1136/adc.2005.083980

Litteraturliste

National Institute for Health and Care Excellence (NICE). Head injury: assessment and early management. NICE Pathways. 2023;doi:https://www.nice.org.uk/guidance/ng232
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet. 2009;374(9696):1160-1170. doi:https://doi.org/10.1016/S0140-6736(09)61558-0
Osmond MH, Klassen TP, Wells GA, Correll R, Jarvis A, Joubert G, Bailey B, Chauvin-Kimoff L, Pusic M, McConnell D, Nijssen-Jordan C, Silver N, Taylor B, Stiell IG. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. Canadian Medical Association Journal. 2010;182(4):341. doi:https://doi.org/10.1503/cmaj.091421
Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Archives of Disease in Childhood. 2006;91(11):885. doi:https://doi.org/10.1136/adc.2005.083980
Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-6. doi:https://doi.org/10.1016/s0140-6736(00)04561-x
Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-105. doi:https://doi.org/10.1056/NEJM200007133430204
Undén J, Ingebrigtsen T, Romner B. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update. BMC medicine. 2013;11(1):50-50. doi:https://doi.org/10.1186/1741-7015-11-50
Astrand R, Rosenlund C, Undén J. Scandinavian guidelines for initial management of minor and moderate head trauma in children. BMC Med. 2016;14(33):1-19. doi:https://doi.org/10.1186/s12916-016-0574-x
Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV, Jr., Zucker MI. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59(4):954-9. doi:https://doi.org/10.1097/01.ta.0000187813.79047.42
van den Brand CL, Foks KA, Lingsma HF, van der Naalt J, Jacobs B, de Jong E, den Boogert HF, Sir Ö, Patka P, Polinder S, Gaakeer MI, Schutte CE, Jie KE, Visee HF, Hunink MGM, et al. Update of the CHIP (CT in Head Injury Patients) decision rule for patients with minor head injury based on a multicenter consecutive case series. Injury. 2022;53(9):2979-2987. doi:https://doi.org/10.1016/j.injury.2022.07.001
Lorton F, Poullaouec C, Legallais E, Simon-Pimmel J, Chêne MA, Leroy H, Roy M, Launay E, Gras-Le Guen C. Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study. Scand J Trauma Resusc Emerg Med. 2016;24:98. doi:https://doi.org/10.1186/s13049-016-0287-3