Salter Harris Fractures

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CT Imaging in Minor Head Injury

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