Comparing Decision Rules for Computed Tomography After Mild Traumatic Brain Injury

Use of computed tomography (CT) after mild traumatic brain injury continues to be high, even as percentages of clinically significant findings on CT remain in the low single digits. Clinical decision rules to identify patients for whom CT can be avoided include the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR), National Institute for Health and Care Excellence (NICE) guideline, and the as-yet unvalidated CT in Head Injury Patients (CHIP) rule.

These authors prospectively validated these four rules in six Dutch emergency departments. The main outcome measure was any intracranial finding on CT, including intracranial hemorrhage, parenchymal injury, and skull fracture. Secondary outcomes included “potential neurosurgical lesions,” wh…