More et al reported the CTHEAD prediction rule for identifying older adults with minor head injury who do not a require a head CT. This can help to reduce unnecessary studies. The authors are from Yokohama Municipal Citizen's Hospital, Yokohama City University Medical Center, and Yokohama Minami Kyousai Hospital in Japan.
CTHEAD = Computed Tomography of the Head for the patient at advanced age
Patient selection: adult >= 65 years old with minor trauma, with a GCS >= 13
Exclusion: GCS < 13, anticoagulated, focal neurological findings, posttraumatic seizures, penetrating injury, depressed fracture, unknown mechanism
Outcome: traumatic lesion identified on CT scan
The outcome was present in 9% of subjects.
Parameters:
(1) high-risk mechanism of injury
(2) vomiting
(3) witnessed loss of consciousness
(4) antegrade amnesia
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Finding
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Points
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absent
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0
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present
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1
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score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• If the score is 0, then the negative predictive value is 0.95. A CT scan of the head is not indicated in these patients.
• For a score >= 1, the positive predictive value was from 0.16 to 0.21.
