Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: Accompanying our article on the CCHR1 was an editorial by Dr Haydel,2 who was not identified as the developer of the NOC. We have concerns about Haydel's statement that in the United States all intracranial lesions are considered clinically important. We are aware of many patients with minimal CT lesions, often not even observed on CT scan by the attending emergency physician, who neurosurgeons do not feel require hospital admission or specialized follow-up. In our combined dataset of 5828 minor head injury cases in the CCHR derivation and validation cohorts, none of the 189 patients with clinically unimportant brain injury experienced a bad outcome or required neurosurgical intervention.1,3 Our tightly structured definition of clinically unimportant brain injury requires the patients to be neurologically intact and have 1 of 4 types of trivial lesion on CT scan. The cited study by Atzema et al4 described patients with severe, obvious injury and GCS scores as low as 3. Although some patients with clinically unimportant brain injury go on to develop the postconcussion syndrome, so do some patients with normal CT scan. There is no evidence that initial CT is useful in predicting this outcome.
Stiell IG, Clement CM, Rowe BH, Brison R, Wells GA. CT Scanning for Minor Head Injury. JAMA. 2006;295(5):497-498. doi:10.1001/jama.295.5.498-a