Criteria
Glasgow Coma Scale (GCS)[34]
GCS has 3 components: best eye response (E), best verbal response (V), and best motor response (M).
Eye opening: spontaneous (4 points); on verbal stimulation (3 points); on painful stimulation (2 points); none (1 point)
Verbal response: oriented, fluent, coherent (5 points); disorientated, confused (4 points); incoherent (3 points); incomprehensible (2 points); none (1 point)
Motor response: obeys commands (6 points); localizes to stimulus (5 points); withdraws to stimulus (4 points); decorticate or flexor posturing (3 points); decerebrate or extensor posturing (2 points); none (1 point).
The total GCS score is the sum of points from eye opening, verbal response, and motor response scores (from 3 to 15 points total):
GCS of 13 to 15 is associated with mild brain injury
GCS of 9 to 12 is associated with moderate brain injury
GCS of <8 is associated with severe brain injury.
New Orleans criteria[29]
CT is required for patients with minor head trauma (minor head injury was defined as loss of consciousness in patients with normal findings on a brief neurologic exam and a GCS score of 15, as determined by a physician on arrival at the emergency room), with any one of the following:
Headache
Vomiting
Age >60 years
Drug or alcohol intoxication
Persistent anterograde amnesia (deficits in short-term memory)
Evidence of traumatic soft-tissue or bone injury above clavicles
Seizure (suspected or witnessed).
Canadian CT head rule[30]
A CT head is required for patients with minor head injuries, defined as witnessed loss of consciousness, definite amnesia, or witnessed disorientation in a patient with a GCS score of 13 to 15, with any one of the following:
High risk (for neurologic intervention):
GCS <15 at 2 hours after injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture: hemotympanum, raccoon eyes (periorbital ecchymosis), cerebrospinal fluid otorrhea/rhinorrhea, Battle sign (ecchymosis of the mastoids)
2 or more episodes of vomiting
Age 65 years or above.
Medium risk (for brain injury on CT):
Amnesia for >30 minutes before impact (retrograde amnesia)
Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from height of >3 feet or 5 stairs).
American College of Radiology Appropriateness Criteria: Head trauma[37]
Patients identified as having moderate or high risk for intracranial injury should undergo early post-injury noncontrast CT for evidence of intracerebral hematoma, midline shift, or increased intracranial pressure.
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