For minor head injury patients (GCS 13-15) apply the CCHR or NOC decision making tools to help you decide if a head CT is required.
Canadian CT Head Rule:
Head CT is only required in minor head injury patients with any one of the following:
High Risk Factors (for neurological intervention)
- GCS score <15 at 2 h after injury
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture (haemotympanum, ‘racoon’ eyes, cerebrospinal fluid otorrhoea/rhinorrhoea, or Battle’s sign)
- Vomiting ( > two episodes)
- Age 65 years
Medium Risk Factors (for brain injury on CT)
- 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)
But the Rules Don’t Apply If:
- GCS < 13
- Patient taking coumadin or had a bleeding disorder
- Obvious open skull fracture
- Age < 16 yo
- Non-traumatic
MDCalc: Canadian CT Head Rule Tool
New Orleans Criteria:
Presence of one or more of the following seven findings requires a head CT:
- Headache
- Vomitting
- Age > 60 yo
- Drug or alcohol intoxication
- Deficits in short-term memory
- Physical evidence of trauma above the clavicles
- Seizure
MDCalc: New Orleans Criteria Tool
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