Physics:Canadian CT head rule
The Canadian CT head rule (abbreviated CCTHR or CCHR; also sometimes referred to as the Canadian Computed Tomography Head Rule)[1][2] is a medical scale used to decide whether patients with minor head injuries should undergo cranial CT scans. It was originally described by Stiell et al. in a paper published in the Lancet in 2001, in which they initially used it only on patients with Glasgow Coma Scale scores of between 13 and 15.[3] Since then, the CCTHR has become the most widely researched and extensively validated rule of its kind, though a 2011 systematic review noted that "its exclusion criteria make it difficult to apply universally."[1]
Criteria
The CCTHR excludes patients who:
- did not experience a traumatic brain injury
- have a Glasgow Coma Scale score of lower than 13,
- are under the age of 16,
- has a bleeding disorder or is using warfarin, and/or
- has a visible open skull fracture.[4]
Under the CCTHR, patients with minor head injuries should only receive CT scans if one or more of the following criteria are met:[4]
- Glasgow Coma Scale score lower than 15 at 2 hours after injury
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture
- Two or more episodes of vomiting
- Age 65 or older
- Amnesia before impact of 30 or more minutes
- Dangerous mechanism (this is defined by Stiell et al. (2005) as "a pedestrian struck by a motor vehicle, an occupant ejected from a motor vehicle, or a fall from an elevation of 3 or more feet or 5 stairs."[4])
The first five criteria are considered "high-risk", whereas criteria 6 and 7 are considered "medium-risk".[4]
References
- ↑ 1.0 1.1 "Clinical decision rules for adults with minor head injury: a systematic review". The Journal of Trauma 71 (1): 245–51. July 2011. doi:10.1097/TA.0b013e31820d090f. PMID 21818031. https://figshare.com/articles/poster/Clinical_decision_rules_for_adults_with_minor_head_injury_a_systematic_review/11889807.
- ↑ "Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department". BMJ Open Quality 9 (1): e000811. February 2020. doi:10.1136/bmjoq-2019-000811. PMID 32019751.
- ↑ "The Canadian CT Head Rule for patients with minor head injury". Lancet 357 (9266): 1391–6. May 2001. doi:10.1016/s0140-6736(00)04561-x. PMID 11356436.
- ↑ 4.0 4.1 4.2 4.3 "Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury". JAMA 294 (12): 1511–8. September 2005. doi:10.1001/jama.294.12.1511. PMID 16189364.
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