Clinical decision rules for head CT in trauma
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Background
Decision Rule Performance
- Canadian
- Sn 99%, Sp 47%
- New Orleans
- Sn 99%, Sp 33%
- Nexus II
- 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:
- Age >65 years
- Vomiting >2 times
- Suspected open or depressed skull fracture
- Signs suggesting basal skull fracture:
- Hemotympanum
- Racoon eyes
- CSF otorrhea or rhinorrhea
- Battle's sign
- GCS <15 at 2 hours post injury
- Amnesia before impact >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 ALL of the following are absent:
- 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 ALL of the following are absent:
- Age ≥ 65yr
- Evidence of significant skull fx
- Scalp hematoma
- Neurologic deficit
- Altered level of alertness
- Abnormal behavior
- Coagulopathy
- Recurrent or forceful vomiting
Pediatrics
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