--Papa et al. study looked at both decision rules (link below)
--314 patients (73%) had a GCS of 15
--22 of the 314 (7%) had evidence of a traumatic intracranial lesion on CT
--3 of 314 (1.0%) required neurosurgical intervention
NEW ORLEANS CRITERIA (if ANY of these are true, then do a CT ):
- headache
- vomiting
- age > 60 years
- drug or alcohol intoxication
- deficits in short-term memory
- evidence of trauma above the clavicles
- seizure
CANADIAN CT HEAD RULES (if ANY of these are true, then do a CT):
- GCS < 13
- failure to reach GCS of 15 within 2 h
- suspected open skull fracture
- any sign of basal skull fracture
- vomiting >2 episodes
- age >65 years
- amnesia before impact >30 min
- dangerous mechanism of injury (pedestrian struck by car, ejection from MVC, fall > 3 feet or > 5 stairs)
--NOC and CCHR both had 100% sensitivity (95% confidence interval [CI] = 82% to 100%)
--CCHR was more specific (36.3% specificity) for detecting any traumatic intracranial lesion on CT vs. NOC (10.2% specificity)
Reference(s): study; mdcalc: canadian; mdcalc: new orleans; picture
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