Indications for Head CT After Motor Vehicle Collision

Clinical Decision Rules

The American College of Radiology recommends head CT for patients with a GCS score <15 at 2 hours after injury, suspected open or depressed skull fracture, signs of basilar skull fracture, vomiting ≥2 episodes, or age ≥65 years 1, 2, 3
The Canadian CT Head Rule indicates head CT for patients with medium-risk factors, including amnesia >30 minutes before impact or dangerous mechanism of injury 1, 3
The New Orleans Criteria suggest head CT for patients with headache, vomiting, age >60 years, drug or alcohol intoxication, persistent anterograde amnesia, physical evidence of trauma above the clavicle, or seizure 2, 3, 4

The American College of Radiology recommends head CT for patients with neurological deficits, including any focal neurological signs that suggest possible intracranial injury 1, 3
The American College of Radiology also recommends head CT for patients with altered mental status, including decreased level of consciousness or confusion 5, 3
Severe headache or vomiting may indicate elevated intracranial pressure and warrant head CT 3, 4
Anticoagulation therapy increases the risk of intracranial bleeding and should be considered when deciding on head CT 3

Mechanism of injury, including high-speed collisions or rollovers, may increase the risk of traumatic head injury and should be considered when deciding on head CT 1, 3

A normal neurological examination with GCS 15, no loss of consciousness or amnesia, no headache or vomiting, no physical evidence of trauma above the clavicle, and no anticoagulant therapy may allow head CT to be safely avoided 1, 2, 6