This document summarizes guidelines for head CT scans in adults and children presenting to the emergency department with head trauma. It outlines criteria for when to CT scan based on factors like Glasgow Coma Scale score, loss of consciousness, age, mechanism of injury, vomiting, and neurological symptoms. It also provides recommendations for when to perform a repeat CT scan if symptoms worsen or change. The guidelines aim to identify clinically significant traumatic brain injuries requiring intervention while avoiding unnecessary radiation exposure from CT scans.

1. Head trauma:
When to CT adults and kids in ED
NZ guidelines
Anna Waterfield
ED RMO
June 2014

2. Alternative guidelines
● Canadian CT head rules Stiell IG et al, Ann Emerg Med
2001
● New Orleans Haydel et al, NEJM 2000
● NEXUS II Mower et al, J Trauma, 2005
● PECARN Lancet 2009

3. Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation, ACC evidence-
based best practice guideline summary, March 2007, updated 2013
NZ Guidelines
● NZ Guidelines Group, ACC funded
● Includes pre-/post-hospital care
● Clinically significant: ‘need for
intervention/care/support’
● Classification:
Severity of TBI GCS
Mild 13-15
Moderate 9-12
Severe 3-8

4. Traumatic Brain Injury
Acute brain injury for external force with
one or more of:
● Confusion or disorientation
● Loss of consciousness
● Post-traumatic amnesia
● Focal neurological signs
● Seizure
● Intracranial lesion
4

5. When to CT adults
Any TBI TBI + LOC/anterograde
amnesia
GCS<13/GCS 13-14 2h post-
injury
Age >65
Any deterioration in GCS Coagulopathy
Suspected
open/depressed/basal #
High risk MOI e.g. pedestrian
vs car, ejected from vehicle,
fall > 1m / 5 stairs
Seizure (unless recovery is
prompt and complete)
Focal neurology
>1 vomit
Retrograde amnesia >30min
.“The decision to CT scan should be applied regardless of the influence of intoxication”

6. When to CT kids
0-16 years <2 years – additional risk
factors
Post-injury adverse features
e.g. focal neurology/seizure
(except immediate seizure)
Occipital/temporal/parietal
soft tissue injury –
swelling/haematoma
GCS<13 or any decrease
Skull #
NAI
Fall >1m or >5 stairs (less if
younger)
Lethargic/irritable

7. 7

8. 8

9. Repeat CT in adults/kids?
● New severe/increasing headache or
persistent vomiting
● New agitation/abnormal behaviour
● >30 min 1 point drop in GCS
● >2 GCS points drop
● New/evolving neurology
● First CT NAD + GCS<15 after 24h

10. Summary
● All guidelines similar
● Instinct
● Resources incl. seniors/specialists
● Beware:
◦ Iatrogenic anticoagulation
◦ Infants
◦ Insidious deterioration
◦ Intoxication