Canadian CT head rule
Updates to Article Attributes
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was changed:
The Canadian CT head rule (CCTHR) is a validated clinical decision rule to determine the need for CT head in emergency department patients with minor head injuries.
Inclusion criteria
Patient has suffered minor head trauma with resultant
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LOCloss of conciousness - GCS 13-15
-
Confusionconfusion -
Amnesiaamnesia after event
Exclusion Criteria
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Anticoagulantanticoagulant medication or bleeding disorder -
Ageage <16 -
Seizureseizure
Risk Factors
The initial study was carried out in 10 Canadian emergency departments amongst 3121 patients. Five high risk factors and two medium risk factors were identified to predict the need for subsequent neurosurgical intervention1.
High risk factors
GCS < 15 two hours post injury
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Suspectedsuspected open skull fracture Signsign of base of skull fractureVomitingvomiting more than twiceAgeage > 65
Medium risk factors
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Amnesiaamnesia post event > 30 min -
Dangerousdangerous mechanism of injury - Pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from > 3 feet or 5 stairs.
Interpretation
If the patient does not have any of the risk factors identified by the CCTHR then the a CT Head is deemed unnecessary. If any of the above risk factors are identified then a CT head should be obtained.
Several studies have found the CCTHR to be highly sensitive in identifying injuries requiring neurosurgical intervention (80-100%)1-5 , with varying degrees of specificity (49.6-80.7%)1-5.
-<p>The Canadian CT head rule (CCTHR) is a validated clinical decision rule to determine the need for CT head in emergency department patients with minor head injuries.</p><p><strong>Inclusion criteria</strong></p><p>Patient has suffered minor head trauma with resultant</p><ul>-<li>LOC</li>- +<p>The <strong>Canadian CT head rule (CCTHR)</strong> is a validated clinical decision rule to determine the need for CT head in emergency department patients with minor head injuries.</p><p><strong>Inclusion criteria</strong></p><p>Patient has suffered minor head trauma with resultant</p><ul>
- +<li>loss of conciousness</li>
-<li>Confusion</li>-<li>Amnesia after event</li>- +<li>confusion</li>
- +<li>amnesia after event</li>
-<li>Anticoagulant medication or bleeding disorder</li>-<li>Age <16</li>-<li>Seizure</li>-</ul><p> </p><p>The initial study was carried out in 10 Canadian emergency departments amongst 3121 patients. Five high risk factors and two medium risk factors were identified to predict the need for subsequent neurosurgical intervention<sup>1</sup>.</p><p><strong>High risk factors</strong></p><ul>- +<li>anticoagulant medication or bleeding disorder</li>
- +<li>age <16</li>
- +<li>seizure</li>
- +</ul><h4>Risk Factors</h4><p>The initial study was carried out in 10 Canadian emergency departments amongst 3121 patients. Five high risk factors and two medium risk factors were identified to predict the need for subsequent neurosurgical intervention<sup>1</sup>.</p><p><strong>High risk factors</strong></p><ul>
-<li>Suspected open skull fracture</li>-<li><p>Sign of base of skull fracture</p></li>-<li><p>Vomiting more than twice</p></li>-<li><p>Age > 65</p></li>- +<li>suspected open skull fracture</li>
- +<li><p>sign of base of skull fracture</p></li>
- +<li><p>vomiting more than twice</p></li>
- +<li><p>age > 65</p></li>
-<li>Amnesia post event > 30 min</li>-<li>Dangerous mechanism of injury - Pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from > 3 feet or 5 stairs.</li>-</ul><p> </p><p> </p><h6>Interpretation</h6><p>If the patient does not have any of the risk factors identified by the CCTHR then the a CT Head is deemed unnecessary. If any of the above risk factors are identified then a CT head should be obtained.</p><p> </p><p>Several studies have found the CCTHR to be highly sensitive in identifying injuries requiring neurosurgical intervention (80-100%)<sup>1-5 </sup>, with varying degrees of specificity (49.6-80.7%)<sup>1-5</sup>.</p>- +<li>amnesia post event > 30 min</li>
- +<li>dangerous mechanism of injury - Pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from > 3 feet or 5 stairs.</li>
- +</ul><p> </p><h4>Interpretation</h4><p>If the patient does not have any of the risk factors identified by the CCTHR then the a CT Head is deemed unnecessary. If any of the above risk factors are identified then a CT head should be obtained.</p><p> </p><p>Several studies have found the CCTHR to be highly sensitive in identifying injuries requiring neurosurgical intervention (80-100%)<sup>1-5 </sup>, with varying degrees of specificity (49.6-80.7%)<sup>1-5</sup>.</p>
References changed:
- 5. Kavalci C, Aksel G, Salt O et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in Patients with Minor Head Injury. World J Emerg Surg. 2014;9(1):31. <a href="https://doi.org/10.1186/1749-7922-9-31">doi:10.1186/1749-7922-9-31</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24742359">Pubmed</a>
- 1. Stiell I, Wells G, Vandemheen K et al. The Canadian CT Head Rule for Patients with Minor Head Injury. Lancet. 2001;357(9266):1391-6. <a href="https://doi.org/10.1016/s0140-6736(00)04561-x">doi:10.1016/s0140-6736(00)04561-x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11356436">Pubmed</a>
- 2. Stiell I, Clement C, Rowe B et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in Patients with Minor Head Injury. JAMA. 2005;294(12):1511-8. <a href="https://doi.org/10.1001/jama.294.12.1511">doi:10.1001/jama.294.12.1511</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16189364">Pubmed</a>
- 4. Papa L, Stiell I, Clement C 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;19(1):2-10. <a href="https://doi.org/10.1111/j.1553-2712.2011.01247.x">doi:10.1111/j.1553-2712.2011.01247.x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22251188">Pubmed</a>
- 3. Wolf H, Machold W, Frantal S et al. Risk Factors Indicating the Need for Cranial CT Scans in Elderly Patients with Head Trauma: An Austrian Trial and Comparison with the Canadian CT Head Rule. J Neurosurg. 2014;120(2):447-52. <a href="https://doi.org/10.3171/2013.10.JNS13726">doi:10.3171/2013.10.JNS13726</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24313609">Pubmed</a>
Sections changed:
- Approach
Systems changed:
- Trauma
- Central Nervous System
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