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September 28, 2005

Clinical Decision Instruments for CT Scanning in Minor Head Injury

Author Affiliations

Author Affiliation: Section of Emergency Medicine, Department of Medicine, Louisiana State University Health Science Center, New Orleans.

JAMA. 2005;294(12):1551-1553. doi:10.1001/jama.294.12.1551

Approximately 1 million patients with minor head injury are evaluated in US emergency departments and primary care offices annually.1,2 Less than 10% of patients with a normal level of consciousness after minor head trauma have intracranial injury and less than 1% require neurosurgical intervention.35 The goal of identifying the few patients with intracranial injury after minor head trauma has led to 2 approaches to computed tomography (CT) use in the United States: routinely scanning all patients with head trauma and loss of consciousness or reliance on clinical judgment to guide in CT use. Routine scanning results in large health care expenditures, whereas reliance on clinical judgment could reduce CT use, but at the cost of missing 20% of patients with intracranial injury.6,7

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