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New Orleans/Charity Head Trauma/Injury Rule

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

New Orleans CT Head Criteria Only Apply to GCS 15 Patients.

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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