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CT Scanning for Minor Head Injury
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To the Editor: Dr Smits and colleagues1 generated independently derived data on the performance of both the New Orleans Criteria (NOC) and the Canadian CT Head Rule (CCHR) for the use of computed tomography (CT) in patients with minor head injury. Although it is reassuring that both rules have high sensitivity for neurosurgical intervention, the sensitivity of the CCHR for clinically important findings appears to be too low (83.4%-87.2%) to support selective use of CT for minor head trauma.
However, the patient inclusion criteria used in their study are different from those applied in common practice in the United States.2 Therefore, I would like to know the sensitivity and specificity of the CCHR as well as the distribution of abnormal CT findings for the subset of patients with a Glasgow Coma Scale (GCS) score of 15, no focal neurological deficit, and no use of anticoagulation. I would anticipate improved sensitivity, . . . [Full Text of this Article]
Eric Schwam, MD
schwam@massmed.org
Department of Emergency Medicine
Brown University
Providence, RI
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