View source for Clinical decision rules for head CT in trauma

==Background==
Clinical decision rules to guide providers when determining which patients require urgent CT neuroimaging.

===Decision Rule Performance===
{| class="wikitable"
|-
!   !! Canadian Head CT Rule<ref>[[EBQ:Canadian Head CT Rule]]</ref> !! New Orleans !! NEXUS II !! ACEP Clinical Policy
|-
| Sensitivity || 99% || 99% || 97% || Unknown
|-
| Specificity || 47% || 33% || 47% || Unknown
|}

==[[EBQ:Canadian Head CT Rule|Canadian CT Head Rule]]<ref>[[EBQ:Canadian Head CT Rule]]</ref>==
===Inclusion Criteria===
*[[GCS]] 13-15
*Age ≥ 16yr
*No coagulopathy nor on anti-coagulation
*No obvious open skull fracture
===Rule===
''[[Head CT]] not required if NONE of the following are present''
*Age ≥ 65 years 
*[[Vomiting]] > 2 time
*Suspected open or depressed [[Skull Fracture]]
*Signs suggesting basal skull fracture:
**Hemotympanum
**Racoon eyes
**CSF otorrhea or rhinorrhea
**Battle's sign (bruising around mastoid process)
*[[GCS]] < 15 at 2 hours post injury
*Retrograde Amnesia > 30min
*Dangerous mechanism
**Pedestrian struck by vehicle
**Ejection from motor vehicle
**Fall from elevation >3 feet or 5 stairs

==New Orleans Rule==
===Inclusion Criteria===
*Age >18
*[[GCS]] 15
*Blunt head trauma occurring within previous 24hr causing LOC, amnesia, or disorientation
===Rule===
''[[Head CT]] not required if NONE of the following are present''
*[[Headache]]
*[[Vomiting]]
*Age >60yr
*Drug or [[Alcohol Intoxication]]
*Persistent anterograde amnesia (deficits in short-term memory)
*Visible trauma above the clavicles
*[[Seizure]]

==Nexus II Rule==
===Rule===
''[[Head CT]] not required if NONE of the following are present''
*Age ≥ 65yr
*Evidence of significant [[Skull Fracture]]
*Scalp hematoma
*Neurologic deficit
*[[Altered Level of Alertness]]
*Abnormal behavior
*[[Coagulopathy]]
*Recurrent or forceful vomiting

==[[ACEP clinical policies|ACEP Clinical Policy (2008)]]==
{{ACEP TBI policy}}

==Pediatrics==
*See [[Head Trauma (Peds)]]
*See [[EBQ:PECARN Pediatric Head CT Rule|PECARN Head CT Rule]]

==See Also==
*[[Head trauma (main)]]
*[[CT Before Lumbar Puncture]]
*[[Head CT]]
*[[Head Trauma (Peds)]]
*[[EBQ:Canadian Head CT Rule]]

==Resources==
<References/>
*Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting; Ann Emerg Med, 2008
*Annals of Emerg Med 2009; 53, 2:180-188.
*http://www.ohri.ca/emerg/cdr/cthead.html 
*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;343:100–5.
*Papa L et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States level I trauma center. Acad Emerg Med 2012 Jan; 19:2

[[Category:Trauma]]
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