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BMJ. 2007 March 31; 334(7595): 660.
PMCID: PMC1839219
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New rule helps predict CT findings in minor head injury

We already have two validated prediction rules for patients with minor head injury. But both are for use only in patients who have been knocked out. Researchers from the Netherlands have developed a third rule to include most patients who remain conscious. The rule predicts who is likely to have a traumatic intracranial lesion by using the presence or absence of major and minor risk factors. The 10 major risk factors include vomiting, prolonged post-traumatic amnesia, a Glasgow coma score below 15, and seizure. Minor risk factors include a fall from a height, any loss of consciousness, and contusion of the skull. Computed tomography (CT) of the head is indicated for anyone with one major or two minor risk factors.

In a cohort of 3181 Dutch patients with minor head injury, the simple version of the rule identified all those who needed neurosurgery (17/3181, 0.5%; sensitivity 100%, 95% CI 82% to 100%) and 96% of those who had any intracranial lesion. It wasn't very specific (25% specificity for intracranial lesions, 23% to 27%), but the authors estimate that it could cut the number of scans after minor head injury by almost a quarter. The new rule, which needs further validation, applies to adults with minor head injury who present with a Glasgow coma score of 13-15.


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