This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Radiologic Imaging  • Computed Tomography  • Emergency Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Accompanying our article on the CCHR¹ was an editorial by Dr Haydel,² who was not identified as the developer of the NOC. We have concerns about Haydel's statement that in the United States all intracranial lesions are considered clinically important. We are aware of many patients with minimal CT lesions, often not even observed on CT scan by the attending emergency physician, who neurosurgeons do not feel require hospital admission or specialized follow-up. In our combined dataset of 5828 minor head injury cases in the CCHR derivation and validation cohorts, none of the 189 patients with clinically unimportant brain injury experienced a bad outcome or required neurosurgical intervention.^{1, 3} Our tightly structured definition of clinically unimportant brain injury requires the patients to be neurologically intact and have 1 of 4 types of trivial lesion on CT scan. The cited study by Atzema et al⁴ described patients with severe, . . . [Full Text of this Article]

Ian G. Stiell, MD, MSc
istiell@ohri.ca
Department of Emergency Medicine
University of Ottawa

Catherine M. Clement, RN
Clinical Epidemiology Program
Ottawa Health Research Institute
Ottawa, Ontario

Brian H. Rowe, MD
Department of Emergency Medicine
University of Alberta
Edmonton

Robert Brison, MD, MPH
Department of Emergency Medicine
Queens University
Kingston, Ontario

George A. Wells, PhD
Department of Epidemiology
University of Ottawa
Ottawa, Ontario

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

CT Scanning for Minor Head Injury
Eric Schwam
JAMA. 2006;295(5):497.
EXTRACT | FULL TEXT  

CT Scanning for Minor Head Injury—Reply
Marion Smits, Diederik W. J. Dippel, and M. G. Myriam Hunink
JAMA. 2006;295(5):497-498.
EXTRACT | FULL TEXT  

External Validation of the Canadian CT Head Rule and the New Orleans Criteria for CT Scanning in Patients With Minor Head Injury
Marion Smits, Diederik W. J. Dippel, Gijs G. de Haan, Heleen M. Dekker, Pieter E. Vos, Digna R. Kool, Paul J. Nederkoorn, Paul A. M. Hofman, Albert Twijnstra, Hervé L. J. Tanghe, and M. G. Myriam Hunink
JAMA. 2005;294(12):1519-1525.
ABSTRACT | FULL TEXT