MDCalc

CHIP (CT in Head Injury Patients) Prediction Rule

Predicts intracranial traumatic CT findings in patients with minor head trauma.

  • Use in patients at least 16 years old presenting within 24 hours of blunt head trauma and GCS 13-15.
  • Note: We recommend using the Canadian CT Head Rule over other adult head trauma decision rules, as it is the most widely validated.

Age

GCS <15

GCS deterioration at 1 hr after presentation
Skull injury
Skull contusion = clinically significant discontinuity of the skin or extensive bruising
Post-traumatic amnesia
Patient cannot recall entire traumatic event
Pedestrian or cyclist versus vehicle
Ejected from vehicle
Vomiting
Defined as an episode of emesis after the traumatic event
Use of anticoagulants
Post-traumatic seizure
Seizure witnessed or suspected after injury
Fall from any elevation
Persistent anterograde amnesia
Any short-term memory deficit
Neurologic deficit
Any abnormality on routine clinical neuro exam indicating a focal cerebral lesion
Loss of consciousness

Result:

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Advice

This prediction rule should support, not replace, clinical judgment.

Management

  • Low risk:

    • Consider observation without immediate imaging if the patient remains clinically stable.

    • Educate the patient and caregivers on warning signs that require re-evaluation.

  • Not low risk: Proceed with urgent head CT imaging to rule out life-threatening intracranial pathology.

Critical Actions

If clinical suspicion for intracranial pathology is high, CT imaging is indicated regardless of the tool’s results.

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