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    Patent Pending

    Canadian CT Head Injury/Trauma Rule

    Clears head injury without imaging.

    INSTRUCTIONS

    Only apply to patients with Glasgow Coma Scale (GCS) 13-15 and at least one of the following:

    • Loss of consciousness.
    • Amnesia to the head injury event.
    • Witnessed disorientation.

    Exclusion criteria:

    • Age <16 years.
    • Blood thinners.
    • Seizure after injury.
    When to Use
    Pearls/Pitfalls
    Why Use
    • The Canadian CT Head Rule is a well-validated clinical decision aid that allows physicians to safely rule out the presence of intracranial injuries that would require neurosurgical intervention without the need for CT imaging.
    • The CCHR has been found to be 70% sensitive for “clinically important” brain injury in EtOH intox patients (Easter 2013).

    The Canadian CT Head Rule (CCHR) was developed to help physicians determine which minor head injury patients need head CT imaging.

    • The original validation trial and multiple subsequent studies (Stiell 2001, Stiell 2005, Stiell 2010) each found the CCHR’s High Risk Criteria to be 100% sensitive for injuries requiring neurosurgical intervention. It has an 87-100% sensitivity for detecting “clinically important” brain injuries that don’t require neurosurgery.
    • The rule excluded patients on oral anticoagulants and anti-platelet agents, so no data is available for these patients.
    • Patients with minimal head injury (i.e., no history of loss of consciousness, amnesia, and confusion) generally do not need a CT scan. For example, patients over 65 years may not need a CT scan just based on their age if they do not have the history mentioned above. When a patient fails the CCHR, use clinical judgment on whether a CT scan is necessary.
    • One study found the CCHR the most consistent, validated, and effective clinical decision rule for minor head injury patients.

    Points to keep in mind:

    • While there is only one US validation study for the CCHR, it was 100% sensitive for clinically important injuries and injuries requiring neurosurgery.
    • A retrospective study in the United Kingdom found that applying the CCHR would have actually resulted in an increase in the number of patients undergoing CT scan in that particular practice setting.
    • There is debate about whether the goal should be to find all intracranial injuries or to find patient-important ones that would require neurosurgical intervention.

    There are more than 8 million patients who present annually to US Emergency Departments for evaluation of head trauma. The vast majority of these patients have minor head trauma that will not require specialized or neurosurgical treatment. At the same time, rates of CT imaging of the head have more than doubled from the early 1990s through the 2000s.

    Exclusion Criteria: If any of the following are true, the CCHR does not apply
    No
    Yes
    No
    Yes
    No
    Yes
    High Risk Criteria: Rules out need for neurosurgical intervention
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    Medium Risk Criteria: In addition to above, rules out “clinically important” brain injury (positive CT's that normally require admission)
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Ian Stiell

    About the Creator

    Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa; Distinguished Professor and University Health Research Chair, University of Ottawa; Senior Scientist, Ottawa Hospital Research Institute; and Emergency Physician, The Ottawa Hospital. He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care. Dr. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. Dr. Stiell is a Member of the Institute of Medicine of the U.S. National Academies of Science.

    To read more about Dr. Stiell's work, visit his website.

    To view Dr. Ian Stiell's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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