Smits et al developed the CT in Head Injury Patients (CHIP) prediction rule. This can help identify which patients do or do not require a CT exam following minor head injury. The authors are from Erasmus University, Nijmegen University, and Maastricht University in The Netherlands.
NOTE: This is the simple prediction model. A full statistical model is shown in Table 2.
Patient selection - age >= 16 years AND one of the following:
(1) head injury with Glasgow coma score (GCS) 13 or 14
(2) head injury with Glasgow coma score (GCS) 15 AND one or more of the following:
(2a) loss of consciousness
(2b) short-term memory loss
(2c) amnesia for the traumatic event
(2d) posttraumatic seizure
(2e) vomiting
(2f) severe headache
(2g) intoxication
(2h) history of coagulopathy
(2i) history of anticoagulants
(2j) physical evidence of trauma above the clavicles
(2k) neurologic deficit
Parameters:
(1) age of the patient in years
(2) GCS score
(3) deterioration in Glasgow coma score at 1 hour after presentation
(4) pedestrian or cyclist versus vehicle
(5) ejected from vehicle
(6) vomiting
(7) duration of posttraumatic amnesia in hours
(8) persistent antegrade amnesia
(9) signs of skull fracture (CSF leakage; raccoon eye; bleeding from ear; palpable discontinuity of the skull)
(10) skull contusion
(11) use of anticoagulants
(12) posttraumatic seizure
(13) neurologic deficit
(14) loss of consciousness
(15) fall from any height
|
Parameter |
Finding |
Points |
|
age of the patient in years |
< 40 |
0 |
|
|
40 to 60 years |
1 |
|
|
>= 60 years |
2 |
|
Glasgow Coma Score |
15 |
0 |
|
|
13 or 14 |
2 |
|
deterioration in GCS |
none |
0 |
|
|
1 point |
1 |
|
|
>= 2 points |
2 |
|
pedestrian or cyclist |
no |
0 |
|
|
yes |
2 |
|
ejection from vehicle |
no |
0 |
|
|
yes |
2 |
|
vomiting |
no |
0 |
|
|
yes |
2 |
|
posttraumatic amnesia |
< 2 hours |
0 |
|
|
2 to 3.9 hours |
1 |
|
|
>= 4 hours |
2 |
|
persistent antegrade amnesia |
no |
0 |
|
|
yes |
1 |
|
signs of skull fracture |
no |
0 |
|
|
yes |
2 |
|
skull contusion |
no |
0 |
|
|
yes |
1 |
|
anticoagulant therapy |
no |
0 |
|
|
yes |
2 |
|
posttraumatic seizure |
no |
0 |
|
|
yes |
2 |
|
neurologic deficit |
no |
0 |
|
|
yes |
1 |
|
loss of consciousness |
no |
0 |
|
|
yes |
1 |
|
fall from any height |
no |
0 |
|
|
yes |
1 |
where:
• A major criterion is assigned 2 points. A minor criterion is assigned 1 point.
• A coagulopathy is not scored in the table.
total score =
= SUM(points for all 15 parameters)
Interpretation:
• minimum total score: 0
• A head CT scan is done if the total score is >= 2.
Limitations:
• The rule needs to undergo external validation.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
