Evaluation of the Canadian CT Head Rule for Minor Head Trauma in a Tertiary Referral Institution

Abstract

The value of cranial computerized tomography (CT) scan as a method of predicting traumatic brain injury (TBI) in patients with minor head trauma (MHT) is controversial. We aimed to assess the effectiveness of cranial CT by retrospectively studying head-injured patients presenting to the accident and emergency (AE King Khalid University Hospital, Riyadh, Saudi Arabia. To determine the frequency of utilization, yield for TBI, incidence of missed injuries, and to assess the effectiveness of cranial CT for patients with MHT. These retrospective medical records and imaging survey were conducted for 600 consecutive patients. Included in this review were patients above 12 years who sustained acute MHT, defined as witnessed loss of consciousness or amnesia and a Glasgow Coma Scale (GCS) score of 13 or greater. During the year 2004, and over a 10-month period, 600 patients attended the A&E department with MHT. Only 130 patients (21.7%) fulfilled the indication criteria of the Canadian CT Head Rule, and were referred for cranial CT scan. CT scans demonstrated evidence of intracranial injuries in 24 patients (18.5%), 19 of them admitted for observation, and only two patients (1.5%) required craniotomy for evacuation of extradural hematoma. Brain CT was normal in 100 patients (77%), showing incidental findings unrelated to head injury in five patients, and one scan could not be interpreted due to poor quality. No one died as a consequence of MHT, and no one reported again to A&E of the discharged group, without CT scan. There have been several studies examining the indications for CT scan imaging in MHT. Canadian CT Head Rule can accurately identify patients who have no need for head CT imaging, however, if applied to the wrong patients or used incorrectly, it may lead to unnecessary referrals for CT. If successfully validated, this simple decision rule may lead to a more standardized approach to the A&E investigation and management of patients with MHT, this would potentially reduce costs, and so should be considered for application by all A&E, neurosurgery, and radiology departments.