Introduction Mild traumatic brain injury is commonly defined as Glasgow Coma Scale (GCS) score on hospital arrival of 13 to 15 Traumatic brain injury victims harboring hematomas are not readily identified on neurologic examination or skull radiography and often do poorly if diagnosis is delayed Cranial computed tomography (CT) scanning plays an important role in the assessment of patients with suspected hematoma CT scans are more expensive To avoid its attendant exposure to potentially harmful radiation Importance Numerous clinical decision aids(6) exist to help decide which head injury patients might benefit from cranial computed tomography. Compare the instruments according to their sensitivity and specificity To benefit of correctly classifying patients as having surgical, nonsurgical, or no intracranial lesions nonsurgical lesions (cerebral contusion, subarachnoid hemorrhage, etc) Canadian CT Head Rules CT of the head is only required for patients with a history of mild head injury within the previous 24 hours and any one of the following risk factors for neurological intervention: (also consider Additional Head CT Indications below). This decision rule is limited by including only patients with loss of consciousness and anterograde amnesia. It also excluded those with abnormal neurologic findings, those on anticoagulants and those with seizures. There has been extensive external validation. 1. High Risk (for neurological intervention) · GCS < 15 at two hours after injury. · Suspected open or depressed skull fracture. This is a clinical rather than X-ray diagnosis. · Any sign of basal skull fracture (hemotympanum, "raccoon" eyes, cerebrospinal fluid otorrhea/rhinorrhea, Battle's sign). · Vomiting 2 or more episodes. · Age > 65. 2. Medium Risk (for brain injury on CT) · Amnesia before impact > 30 minutes · Dangerous Mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from height >3 feet or 5 stairs). Criteria proposed by the NCWFS for classification, diagnosis, and treatment of patients with mild head injury New Orleans Criteria for Determining if CT Is Indicated After Minor Head Injury CT is needed if the patient meets one or more of the following criteria: 1. Headache 2. Vomiting 3. Age older than 60 years 4. Drug or alcohol intoxication 5. Persistent anterograde amnesia (deficits in short-term memory) 6. Visible trauma above the clavicle 7. Seizure *-Applicable for adults with a normal Glasgow Coma Scale score of 15 and blunt head trauma that occurred within the previous 24 hours that caused loss of consciousness, definite amnesia, or witnessed disorientation. NEXUS II - Decision Instrument (USA) evidence of significant skull fracture scalp hematoma neurologic deficit altered level of alertness, abnormal behaviour coagulopathy persistent vomiting age 65 or more National Institute of Clinical Excellence Criteria for immediate request for CT scan of the head (adults) GCS less than 13 on initial assessment in the emergency department. GCS less than 15 at 2 hours after the injury on assessment in the emergency department. Suspected open or depressed skull fracture. Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign). Post-traumatic seizure. Focal neurological deficit. More than one episode of vomiting. Amnesia for events more than 30 minutes before impact. Scandinavian Neurotrauma Committee guidelines (Scandinavian) Therapeutic anticoagulation or hemophilia Radiographically demonstrated skull fracture Clinical signs of depressed skull fracture or skull base fracture Posttraumatic seizures Shunt-treated hydrocephalus Multiple injuries Thanks!!!