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New Orleans/Charity Head Trauma/Injury Rule

Criteria for which patients are unlikely to require imaging after head trauma.

Use ONLY in head injury patients who are neurologically normal (GCS 15 and normal brief neurological exam).

Advice

  • Consider CT Head pending outcome of the rule.
  • Consider Neurosurgery Consult as per rule guidelines.

Management

In patients with signs of intracranial hemorrhage, contusion, skull fracture, or other abnormalities diagnosed on brain imaging:

  • Always assess ABCs first.
  • Neurosurgery consultation.
  • Consider hypertonic saline or mannitol after consultation with neurosurgery.
  • Admit to neurosurgical ICU for monitoring and further care.

Critical Actions

  • Providers in more conservative settings could consider applying both rules and choosing to image if either rule suggests that a patient is not completely low risk according to their respective criteria.
  • If a trauma patient, with a head injury and loss of consciousness, presenting with a GCS 15 is positive for any of the NOC (age >60, headache, vomiting, alcohol or drug intoxication, persistent anterograde amnesia, visible trauma above the clavicle or seizures) then they require a CT scan of the head to evaluate for intracranial injury.
  • If the patient does not have any of the NOC then they can be discharged without undergoing a CT of the head and without the need for any further clinical observation.
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