Is a computed tomography (CT) scan indicated for all head injuries, particularly in patients with cognitive impairment, according to New York (NY) guidelines?

From the Research

Indications for CT Scans in Head Injuries

• The Canadian Computed Tomography Head Rule is a reliable instrument for determining indications for head CT scans, with excellent sensitivity of 100% and fairly good specificity of 48-77% 1.
• Features most predictive of intracranial injuries include disorientation, abnormal alertness, somnolentia, and neurological deficits 1.
• Patients with no loss of consciousness and in normal physical condition may only require clinical assessment 1.

Clinical Decision Rules for CT Scans

• The use of clinical decision rules, such as the Canadian Computed Tomography Head Rule, can help reduce the number of unnecessary CT scans 1, 2.
• Clinical decision rules can identify patients with minor head injury who do not need to undergo CT scans, with a sensitivity of 100% and specificity of 48-77% 2.
• The New York (NY) guidelines are not explicitly mentioned in the provided studies, but the studies suggest that clinical decision rules can be used to determine the need for CT scans in patients with head injuries.

Specific Indications for CT Scans

• CT scans are indicated in all patients with moderate and severe head injury (GCS ≤12) 3.
• In minor head injury (MHI), CT scans are indicated if any of the following risk factors are present: loss of consciousness >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed 3.
• Low threshold for taking CT scans is advisable in elderly and alcohol-intoxicated patients 3.

Reasons for Ordering CT Scans

• The most common reasons for ordering CT scans include confirming or ruling out traumatic intracranial lesions, expediting diagnosis, and following guidelines 4.
• Fear of missing a traumatic intracranial lesion and fear of being sued are also common reasons for ordering CT scans 4.