EBQ:Canadian Head CT Rule: Difference between revisions
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==Design== | ==Design== | ||
*Prospective cohort study in 10 Canadian community and teaching institutions | |||
*N=3121 | |||
==Population== | ==Population== | ||
===Inclusion Criteria=== | ===Inclusion Criteria=== | ||
*Blunt Trauma to the head causing witnessed loss of consciousness, definite amnesia, or witnessed disorientation) | |||
*GCS ≥ 13 on ED arrival | |||
*Head injury within the last 24 hours | |||
===Exclusion Criteria=== | ===Exclusion Criteria=== | ||
*Less than 16 years old | |||
*Minimal head injury (no loss of consciousness, amnesia, or disorientation) | |||
*No clear history of trauma as the primary event (eg, primary seizure or syncope) | |||
*Obvious penetrating skull injury or obvious depressed fracture | |||
*Acute focal neurological deficit | |||
*Unstable vital signs associated with major trauma | |||
*Seizure before assessment in the ED | |||
*Bleeding disorder | |||
*Using oral anticoagulants | |||
*Returned for reassessment of the same head injury | |||
*Pregnant | |||
===Baseline Characteristics=== | ===Baseline Characteristics=== | ||
Revision as of 16:29, 18 January 2014
incomplete Journal Club Article
Stiell IG, et al. "The Canadian CT Head Rule for patients with minor head trauma". The Lancet. 2001. 357(9266):1391-96.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
Can a decision rule be used to determine which patients require CT imaging after head trauma?
Conclusion
The Canadian CT head rule is a effective method for determining the need for a patient to receive a non contrast brain CT after head trauma.
Major Points
The trial found that the following criteria had 100% sensitivity for identifying patient at risk for neurologic intervention with minor head injury
- GCS score <15 at 2h post injury
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture (hemotympanum, ‘racoon’ eyes, cerebrospinal fluid otorrhoea/rhinorrhoea, Battle’s sign)
- Vomiting ≥ 2episodes
- Age ≥ 65 years
- Minor head injury is defined as witnessed loss of consciousness, definite amnesia, or witnessed disorientation in a patients with a GCS score of 13–15
The moderate risk group (for brain injury on CT) was identified with 95% sensitivity if any of the following were present:
- Amnesia before impact >30 min
- Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from height >3 feet or five stairs)
Design
- Prospective cohort study in 10 Canadian community and teaching institutions
- N=3121
Population
Inclusion Criteria
- Blunt Trauma to the head causing witnessed loss of consciousness, definite amnesia, or witnessed disorientation)
- GCS ≥ 13 on ED arrival
- Head injury within the last 24 hours
Exclusion Criteria
- Less than 16 years old
- Minimal head injury (no loss of consciousness, amnesia, or disorientation)
- No clear history of trauma as the primary event (eg, primary seizure or syncope)
- Obvious penetrating skull injury or obvious depressed fracture
- Acute focal neurological deficit
- Unstable vital signs associated with major trauma
- Seizure before assessment in the ED
- Bleeding disorder
- Using oral anticoagulants
- Returned for reassessment of the same head injury
- Pregnant