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CARPHOLOGY by Rajendra

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Head injury—to scan or not to scan

We already have the New Orleans criteria and the Canadian CT head rule. We now have a Dutch rule to help clinicians decide which patients with minor head injuries should have a CT brain scan, which they say is indicated if one major or two minor criteria are present. This rule can be used in patients who may or may not have lost consciousness and is based on a large prospective study of 3181 adults with minor head injury. The risk factors studied are mostly the usual suspects from the other rules such as age; the Glasgow Coma Scale score; skull fracture; post-traumatic vomiting; amnesia; or seizure. The rule successfully identified patients who had intracranial CT findings of injury (sensitivity, approximately 95%) or needed neurosurgical intervention (sensitivity, 100%) but it has still to be externally validated. None of these rules will work if clinicians miss a risk factor during history taking or examination.

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