to CT or not CT?: Canadian CT Head Rule & New Orleans Criteria

9 May

CT or NOT?

–Papa et al. study looked at both decision rules (link below)
–314 patients (73%) had a GCS of 15
–22 of the 314 (7%) had evidence of a traumatic intracranial lesion on CT
3 of 314 (1.0%) required neurosurgical intervention


NEW ORLEANS CRITERIA (if ANY of these are true, then do a CT ):
  • headache
  • vomiting
  • age > 60 years
  • drug or alcohol intoxication
  • deficits in short-term memory
  • evidence of trauma above the clavicles
  • seizure

CANADIAN CT HEAD RULES (if ANY of these are true, then do a CT):
  • GCS < 13
  • failure to reach GCS of 15 within 2 h
  • suspected open skull fracture
  • any sign of basal skull fracture
  • vomiting >2 episodes
  • age >65 years
  • amnesia before impact >30 min 
  • dangerous mechanism of injury (pedestrian struck by car, ejection from MVC, fall > 3 feet or > 5 stairs)

–NOC and CCHR both had 100% sensitivity (95% confidence interval [CI] = 82% to 100%)

CCHR was more specific (36.3% specificity) for detecting any traumatic intracranial lesion on CT vs. NOC (10.2% specificity)



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