David Rosengren, MBBS FACEM, Staff Specialist, Sean Rothwell, MBBS, Registrar, Anthony FT Brown, MBChB FRCP FRCS(Ed) FACEM, FFAEM, Associate Professor, Kevin Chu, MBBS, MS, FACEM, Senior Lecturer.
The application of North American CT scan criteria to an Australian population with minor head injury
Version of Record online: 1 JUN 2004
Volume 16, Issue 3, pages 195–200, June 2004
How to Cite
Rosengren, D., Rothwell, S., Brown, A. F. and Chu, K. (2004), The application of North American CT scan criteria to an Australian population with minor head injury. Emergency Medicine, 16: 195–200. doi: 10.1111/j.1742-6723.2004.00563.x
Conflicts of interest: None
- Issue online: 23 FEB 2009
- Version of Record online: 1 JUN 2004
- Accepted 24 November 2003
- decision making;
- head injury;
- tomography scanners;
- X-ray computed
Objective: To determine potential changes in the number of CT head scans performed if the New Orleans Criteria (NOC) or Canadian CT Head Rule (CCTR) was applied to an Australian emergency department population of minor head injured (MHI) patients.
Methods: A retrospective chart review was conducted in an adult metropolitan teaching hospital in Brisbane. All patients presenting over a 3-month period with a GCS Score of 15 following an MHI and had a CT head scan performed were selected for analysis. Using clinically significant CT abnormalities and neurological intervention as the outcome measures, the NOC and CCTR were applied to determine if CT scanning was considered necessary.
Results: Of the 240 patients reviewed, 230 had a normal CT scan and 10 had clinically significant CT abnormalities. One patient with CT abnormality required neurosurgical intervention. Application of the NOC would have resulted in a 3.8% (95% CI 1.7–7.0%) reduction in CT scans performed without missing any patients with CT abnormalities or requiring neurological intervention. Application of the CCTR using both high and low risk factors would have resulted in a 46.7% (95% CI 40.2–53.2%) reduction in CT scans performed without missing the patient requiring neurological intervention, but would not have detected two patients with clinically significant CT abnormalities.
Conclusion: Neither the NOC nor the CCRT appear suitable for significantly reducing the number of normal CT head scans performed without missing clinically significant CT abnormalities when applied to our current clinical practice.