Volkan Kızılgöz, Sema Avcı, Ali Kemal Sivrioğlu, Hasan Aydın, Türkhun Çetin, Berihat Kızılgöz
  MNJ, pp. 68-75  


Background: Head computed tomography (CT) scans, which provide reliable information to assessor rule out neurological abnormalities and injuries, should be used judiciously to minimize radiation exposure and cost.
Objective: The aim of this study was to evaluate the widely used Canadian CT Head Rule (CCHR) to determine the necessity of head CT scans in patients with minor head trauma.
Methods: This retrospective study included 913 patients with head trauma who were admitted to Harakani State Hospital between June 2014 and December 2017. The patient data were reevaluated according to CCHR and compared with the radiological findings.
Results: There were a total of 556 patients fulfilling the inclusion criteria with a male/female ratio of 2.95 and a mean age of 37 ± 4.24 years. The most common injury mechanism of head trauma was
motor vehicle accidents. Chi square tests were applied for statistical calculations. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CCHR were 93%, 88%, 88%, 94%, and 90%, respectively.
Conclusion: CCHR was highly useful for patients with minor head trauma who could benefit from head CT evaluation with high sensitivity and specificity.


Canadian computed tomography head rule; Mild traumatic brain injury; Traumatic brain injury; Brain injuries; Emergency service

Full Text:



Haydon NB. Head injury: audit of a clinical guideline to justify head CT. J Med Imaging Radiat Oncol; 2013.57(2):161-8. DOI: 10.1111/1754-9485.12007

Papa L, Stiell IG, Clement CM, Pawlowicz A, Wolfram A, Braga C, et al. Performance of the canadian ct head rule and the new orleans criteria for predicting any traumatic intracranial injury on computed tomography in a united states level i trauma center. Acad Emerg Med; 2012.19:2-10. DOI: 10.1111/j.1553-2712.2011.01247.x

Shackford SR, Wald SL, Ross SE, Cogbill TH, Hoyt DB, Morris JA, et al. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma; 1992;33:385-94. PMID: 1404507

Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The canadian ct head rule for patients with minor head injury. Lancet; 2001.357:1391-96. DOI: 10.1016/S01406736(00)04561-X

Smits M, Dippel DW, Nederkoorn PJ, Dekker HM, Vos PE, Kool DR, et al. Minor head injury: CT-based strategies for management—a cost-effectiveness analysis. Radiology; 2010.254:532-40. DOI: 10.1148/radiol.2541081672

Klang E, Beytelman A, Greenberg D, Or J, Guranda L, Konen E, et al. Overuse of head ct examinations for the investigation of minor head trauma: analysis of contributing factors. J Am Coll Radiol; 2017;14:1716. DOI: 10.1016/j.jacr.2016.08.032

Albers CE, von Allmen M, Evangelopoulos DS, Zisakis AK, Zimmermann H, Exadaktylos AK. What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? a retrospective study in 3088 canadian ct head rule patients. Biomed Res Int; 2013.2013:453978. DOI: 10.1155/2013/453978

Raisa N, Sujuti H, Purnomo H, Rahayu M, Dalhar M. The influence of sampling time to serum glial fibrillary acidic protein (gfap) levels in acute stroke. Malang Neurology Journal; 2019.5:30-33. DOI: http://dx.doi.org/10.21776/ub.mnj.2019.005.01.5

National Clinical Guideline Centre. National Institute for Health and Clinical Excellence: guidance. Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults. London, UK: National Institute for Health and Care Excellence; 2014

Schuur JD, Carney DP, Lyn ET, Raja AS, Michael JA, Ross NG, et al. A top-five list for emergency medicine: a pilot project to improve the value of emergency care. JAMA Intern Med; 2014.174(4):50915. DOI: 10.1001/jamainternmed.2013.12688

Haydel MJ, Preston CA, Mills T, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med; 2000.343:100-105. DOI: 10.1056/NEJM200007133430204

Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, et al. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan. SpringerPlus; 2016.5:176. DOI: 10.1186/s40064-016-1781-9

Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, et al. Comparison of the canadian ct head rule and the new orleans criteria in patients with minor head injury. World Journal of Emergency Surgery; 2014.9:31. DOI:10.1186/1749-7922-9-31

Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the canadian ct head rule and the new orleans criteria in patients with minor head injury. JAMA; 2005.294(12):1511-18. DOI: 10.1001/jama.294.12.1511

Bouida W, Marghli S, Souissi S, Ksibi H, Methammem M, Haguiga H, et al. Prediction value of the canadian ct head rule and the new orleans criteria for positive head ct scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Ann Emerg Med; 2013.61(5):521-27. DOI: 10.1016/j.annemergmed.2012.07.016

Ro YS, Shin SD, Holmes JF, Song KJ, Park JO, Cho JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Acad Emerg Med; 2011.18(6):597-604. DOI: 10.1111/j.1553-2712.2011.01094.x


  • There are currently no refbacks.