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QUESTION: In patients with minor head injury, can a clinical decision rule using 7 clinical criteria identify those patients who do not need computed tomography (CT)?
2 cohort studies, one for derivation and one for validation of the clinical criteria.
A large, inner city, level 1 trauma centre in New Orleans, Louisiana, USA.
Consecutive patients with minor head injury (loss of consciousness with normal findings on a brief neurological examination and a score of 15 on the Glasgow Coma Scale) in 2 phases (520 in the derivation set, 909 in the validation set, each with mean age 36 y, 65% men). Inclusion criteria were age ≥3 years and presentation <24 hours after injury.
Description of prediction guide
Prognostic clinical criteria recorded before CT in the derivation set were age and presence of headache, vomiting, drug or alcohol intoxication, short term antegrade memory deficits, seizure, history of coagulopathy, and physical evidence of trauma above the clavicles. For the validation set, the same criteria, excluding history of coagulopathy, were recorded before CT. Patients were …
Source of funding: not stated.
For correspondence: Dr M J Haydel, Emergency Medicine Offices, Charity Hospital, 13th Floor, 1532 Tulane Avenue, New Orleans, LA 70112, USA. Fax +1 504 568 3449.