CT for Minor Head Injury in Adults
Minor head injury is a common reason for patients visiting the emergency department. Most patients to do
not have a cause leading to a severe injury such as bleeding in the brain or skull fracture that would
require use of a CT scan to diagnose. There are excellent evidence-based guidelines to determine which
type of patients need a CT scan based on a careful taking of the medical history and physical
examination, but the majority will not. As CT scans expose patients to ionizing radiation, they should
only be used on patients at risk. This approach is a Choosing Wisely recommendation and has been
endorsed by the American College of Emergency Physicians in conjunction with the Centers for Disease
Control and Prevention, which have published guidelines recommending adherence to clinical decision
rules when determining if a patient requires head CT imaging for these presentations. Within the
Michigan Emergency Department Improvement Collaborative, we measure clinical performance against the
standard of the Canadian CT Head Rule, which has consistently performed well in multiple settings and
MEDIC Adult Minor Head Injury Toolkit
MEDIC Adult Minor Head Injury Toolkit Implementation Guide
MEDIC Reference Card for the Canadian CT Head Rule
MEDIC Supplement for the Canadian CT Head Rule
MEDIC Adult Head Injury Flow Diagram
- Davey K, et al. Application of the Canadian Computed Tomography Head Rule to Patients with Minimal
Head Injury. Annals of Emergency Medicine. 2018;72(4), pp.342-350
- Nishijima DK, et al. Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients with Head
Trauma and Preinjury Warfarin or Clopidrogel Use. Annals of Emergency Medicine.
- Probst MA, et al. Prevalence of Intracranial Injury in Adult Patients with Blunt Head Trauma with
and without Anticoagulant or Antiplatelet Use. Annals of Emergency Medicine. 2020;75(3),
- Ro RS, et al. Comparison of Clinical Performance of Cranial Computed Tomography Rules in Patients
with Minor Head Injury: A Multicenter Prospective Study. Academic Emergency Medicine.
- Smits S, et al. External Validation of the Canadian CT Head Rule and the New Orleans Criteria for CT
Scanning in Patients with Minor Head Injury. JAMA. 2005;294(12), pp.1519-1525
- Stiell IG, et al. The Canadian CT Head Rule for Patients with Minor Head Injury. The
Lancet. 2001;357(9266), pp.1391-1396
Reduction of CT use in Children with Minor Traumatic Head Injury
Minor head injuries are a frequent cause for emergency department visitation by children and CT scans are
often used unnecessarily as a diagnostic tool to exclude serious intracranial injuries. However, the use
of CT scanning exposes children to dangerous radiation, increases risk due to requirements for sedation
medication in young children and adds unnecessary expense when children have very low risk for serious
intracranial injury. Strong medical evidence now endorsed by the American Academy of Pediatrics,
American College of Emergency Physicians and the national Choosing Wisely campaign is now available that
offers detailed guidance to emergency physicians’ decision making to better direct use of CT scans
in children with head injuries. Physician members of MEDIC are now able to easily access their personal
and institutional rates of CT scanning in children meeting criteria for minor head injury through the
MEDIC data platform. They can also directly review cases for which CT scans were done to review patient
records to monitor their own performance. The MEDIC collaborative has adopted both collaborative wide as
well as institutional targets for reduction in overuse of CT scanning for children with minor traumatic
brain injury who meet select criteria.
MEDIC Pediatric Minor Head Injury Toolkit
PECARN Pediatric Minor Head Injury CT Guidelines
MEDIC Reference Card for the PECARN Pediatric Minor Head Injury CT Guidelines
MEDIC Supplement for the PECARN CT Head Guidelines
MEDIC Pediatric Head Injury Ages <2 Flow Diagram
MEDIC Pediatric Head Injury Ages 2-17 Flow Diagram
- Ballard DW, et al. Implementation of a Clinical Decision Support System for Children With Minor
Blunt Head Trauma Who Are at Nonnegligible Risk for Traumatic Brain Injuries. Annals of
Emergency Medicine. 2019;73(5):440-451.
- Dayan PS, et al. Association of Traumatic Brain Injuries With Vomiting in Children With Blunt Head
Trauma. Annals of Emergency Medicine. 2014;63(6):657-665.
- Dayan PS, et al. Headache in Traumatic Brain Injuries From Blunt Head
Trauma. Pediatrics. 2015;135(3):504-512.
- Dayan PS, et al. Risk of Traumatic Brain Injuries in Children Younger than 24 Months With
Isolated Scalp Hematomas. Annals of Emergency Medicine. 2014;64(2):153-162.
- Hess EP, et al. Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children
With Minor Head Trauma. JAMA Network Open. 2018;1(5).
- Kuppermann N, et al. Identification of children at very low risk of clinically-important brain
injuries after head trauma: a prospective cohort study. The Lancet.
- Lee LK, et al. Isolated Loss of Consciousness in Children With Minor Blunt Head
Trauma. JAMA Pediatrics. 2014;168(9):837.
- Nigrovic LE, et al. Prevalence of Clinically Important Traumatic Brain Injuries in Children With
Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms. Arch Pediatr Adolesc
- Varano P, et al. Acute outcomes of isolated cerebral contusions in children with Glasgow Coma Scale
scores of 14 to 15 after blunt head trauma. Journal of Trauma and Acute Care Surgery.