Utility of clinical decision rule for intensive care unit admission in patients with traumatic intracranial hemorrhage

- We sought to externally validate an existing clinical decision rule.
- While validated in an urban setting, it proved less predictive in our rural setting.
- It had sensitivity, specificity, and positive predictive value of 0.92, 0.25, and 0.39.
- Prospective studies need to be conducted to further validate the rules utility.

BackgroundRecent literature suggests the majority of traumatic intracranial hemorrhage does not require intervention. One recently described clinical decision rule was sensitive in identifying patients requiring critical care interventions in an urban setting. We sought to validate its effectiveness in our predominately rural setting.MethodsA retrospective study was conducted of adult patients with traumatic intracranial hemorrhage. The rule, based on age, initial Glasgow coma scale score, and presence of a non-isolated head injury, was applied to externally validate the previously reported findings.ResultsIn our population, the rule displayed a sensitivity of 0.923, specificity of 0.251, positive predictive value of 0.393, and negative predictive value of 0.862. The area under curve was 0.587. While our population has a similar adjusted head injury severity score as that from which the rule was developed, significant differences in age and intracranial hemorrhage pattern were noted.ConclusionsThe rule displayed decreased performance in our population, most likely secondary to differences in age and intracranial hemorrhage patterns. Prospective evaluation and cost-savings analysis are appropriate subsequent steps for the rule.