CANADIAN CT HEAD RULE

SUMMARY

CT scans should be immediately requested if an adult has any one of the following:
1. Any deterioration in condition
2. A GCS score of less than 13 when assessed, irrespective of the time elapsed since the injury
3. A GCS score of 13 or 14 two hours after injury
4. A suspected open or depressed skull fracture
5. Any sign of basal skull fracture (haemotympanum, racoon eyes, CSF rhinorrhoea, otorrhoea, Battle’s sign)
6. Post-traumatic seizure
7. Focal neurological deficit
8. Vomiting after trauma
9. Amnesia for greater than 30 minutes of event before impact
10. Age 65 years or older
11. Coagulopathy (history of bleeding, clotting, disorder, current treatment with anticoagulation)
12. High-risk mechanism of injury
13. New onset severe and persistent headache

Reference(s)

Greenberg, M., 1997. Handbook Of Neurosurgery. 7th ed. Lakeland, Fla.: Greenberg Graphics
Quiñones-HinojosaA. (2012). Schmidek and Sweet: Operative Neurosurgical Techniques: Indications, Methods and Results. 6th ed. Saunders.
Rhoton, A.L. and Congress Of Neurological Surgeons (2003). Rhoton cranial anatomy and surgical approaches. Philadelphia: Lippincott Williams & Wilkins.