Clinical decision rules for head CT in trauma: Difference between revisions

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*Blunt head trauma occurring within previous 24hr causing LOC, amnesia, or disorientation
*Blunt head trauma occurring within previous 24hr causing LOC, amnesia, or disorientation
===Rule===
===Rule===
*Head CT required if ANY of the following are present:
*Head CT not required if ALL of the following are absent:
#Headache
#Headache
#Vomiting
#Vomiting

Revision as of 00:50, 8 August 2013

Background

Decision Rule Performance

  1. Canadian
    1. Sn 99%, Sp 47%
  2. New Orleans
    1. Sn 99%, Sp 33%
  3. Nexus II
    1. Sn 97%, Sp 47%

Canadian Rule

Inclusion Criteria

  • GCS 13-15
  • Age ≥ 16yr
  • No coagulopathy nor on anti-coagulation
  • No obvious open skull fx

Rule

  • Head CT not required if ALL of the following are absent:
  1. Age >65 years
  2. Vomiting >2 times
  3. Suspected open or depressed skull fracture
  4. Signs suggesting basal skull fracture:
    1. Hemotympanum
    2. Racoon eyes
    3. CSF otorrhea or rhinorrhea
    4. Battle's sign
  5. GCS <15 at 2 hours post injury
  6. Amnesia before impact >30min
  7. Dangerous mechanism
    1. Pedestrian struck by vehicle
    2. Ejection from motor vehicle
    3. 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 ALL of the following are absent:
  1. Headache
  2. Vomiting
  3. Age >60yr
  4. Drug or alcohol intoxication
  5. Persistent anterograde amnesia (deficits in short-term memory)
  6. Visible trauma above the clavicles
  7. Seizure

Nexus II Rule

Rule

  • Head CT required if ANY of the following are present:
  1. Age ≥ 65yr
  2. Evidence of significant skull fx
  3. Scalp hematoma
  4. Neurologic deficit
  5. Altered level of alertness
  6. Abnormal behavior
  7. Coagulopathy
  8. Recurrent or forceful vomiting

Pediatrics

See Head Trauma (Peds)

See Also

Source

  • 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