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New Orleans/Charity Head Trauma/Injury Rule

Calculators  Neurology
New orleans/charity head trauma/injury rule is a basic criteria for use of cranial computed tomography (CT) for patients with minor head injury.
Headache
No 0
Yes 1
Vomiting
No 0
Yes 1
Age > 60
No 0
Yes 1
Alcohol or drug intoxication
No 0
Yes 1
Persisent anterograde amnesia (short-term memory deficits)
No 0
Yes 1
Visible trauma above the clavicle
No 0
Yes 1
Seizure
No 0
Yes 1
Result:

Background

Measured Factor
Glasgow coma scale (GCS) score on the basis of series of yes/no questions.
Measured Factor Disease
  • Head trouma
Measured Factor Detail
Glasgow coma scale (GCS) score on the basis of general questions are useful for the determination of severityof the head injury to ensure that the patient needs computed tomography imaging scanning or not. with the use of this criteria the use of computed tomography is minimised foe mild to moderate haed injuries.
Speciality
Neurosurgeon
Body System
Neurology
Measured Factor Low Impact
  • Minor head injury.
Measured Factor High Impact
  • Need of neurosurgical intervention.

Result Interpretation

Ranges Ranges
  • Critical Low: GCS score of 13 showed minor head injury.
  • Critical High: GCS score of 15 showed that there is need of neurosurgical intervention.
  • Normal: <13
Result High Conditions
  • Major head trouma
Test Limitations
The NOC head trauma rule might not be applicatble to all clinical settings as it is much less specific than other better rules available(CCRH).
References: 6

Studies

Study Validation 1
The aim of the study was to determine a strong application of the New Orleans Criteria (NOC), Canadian CT Head Rule (CCHR) and National Emergency X-Radiography Study II (NEXUS II) Utilization in reducing the number of cranial CT scans performed in pediatric patients with head trauma. A total of 2,101 patients with positive CT findings were involved in this study. Patients were then identified who required a scan based on the criteria of the above listed decision instruments. Results showed the sensitivities values of NOC, CCHR and NEXUS II were 96.7% (95%CI 93.1-100), 65.2% (95%CI 55.5-74.9) and 78.3% (95%CI 69.9-86.7), respectively, and negative predictive values were  found to be  98.7%, 97.6% and 97.2%, respectively.
References: 7
Study Validation 2
The objective of this study was to compare the performance of Canadian CT Head Rule (CCHR) and New Orleans Criteria (NOC) for detecting the requirement for neurosurgical intervention in patients with brain injury. The main outcomes measures were Neurosurgical intervention and clinically important brain injury determined by CT and telephone interview. A total of 1822 patients (GCS score of 15, 8) required neurosurgical intervention and 97 patients got a clinically important brain injury. Results showed that CCHR was more specific (76.3% vs 12.1%, P<.001) in predicting need for neurosurgical intervention and clinically important brain injury. This study concluded that CCHR and the NOC had similar high sensitivities of 100% but CCHR had greater specificity for important clinical outcomes than NOC method which can result in reduced imaging rates.
References: 8
Study Validation 3
The objective of this prospective study was to compare the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in patients with head injuries. A total 3181 adult patients with minor head injury and with a Glasgow Coma Scale (GCS) score of 13 to 14 or 15 were recruited in the study. The main outcome was measure of any neurocranial traumatic finding on CT scan. Sensitivity and specificity were calculated for each outcome for CCHR and the NOC. Sensitivity for neurosurgical intervention was found to be 100% for both the CCHR and the NOC.  For neurocranial intervention NOC had a higher sensitivity than CCHR but specificity was low of NOC (3.0%-5.6%) than CCRH (37.2%-39.7%). This study concluded the CCHR would characterize all cases requiring neurosurgical intervention, and has higher potential for reducing the use of CT scans.
References: 9
Study Additional 1
This comparison study was done to evaluate the performance of computed tomography (CT) head rule (CCHR) and New Orleans Criteria (NOC) for predicting strong CT findings in patients with mild traumatic brain injury (TBI). A total of 142 patients (Glasgow coma scale 13–15) with mild TBI were involved in the study. Both the scores were one by one calculated in the patients and their correlation with the presence of important CT finding was observed. Result of multivariate analyses showed that CCHR was significantly more related to important CT findings. Overall CCRH had greater performance than NOC in predicting important CT findings.
References: 10
Study Additional 2
The aim of this observational cohort study was to compare the functioning of The New Orleans Criteria and the Canadian CT Head Rule in scrutinizing the patients with intracranial traumatic lesions and who need immediate neurosurgical intervention after mild head injury. 1582 patients with mild TBI were involved in the study and Neurosurgical intervention was conducted in 34 patients and 218 patients were identified for positive CT findings. Results showed that CCHS had higher sensitivity (100%) when compared with NOC (82%) rule. This study concluded that CCHS rule outperforms the NOC rule in predicting the intracranial traumatic lesions and patients who need urgent intervention.
References: 11

References

  1. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8
  2. Smits M, Dippel DW, De haan GG, Dekker HM, Vos PE, Kool DR, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519-25
  3. Bouida W, Marghli S, Souissi S, Ksibi H, Methammem M, Haguiga H, et al. Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Ann Emerg Med. 2013;61(5):521-7
  4. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, Deblieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-5
  5. Levine Z. Mild traumatic brain injury: part 1: determining the need to scan. Can Fam Physician. 2010;56(4):346-9.
  6. Papa L, Stiell IG, Clement CM, Pawlowicz A, Wolfram A, Braga C, et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med. 2012;19(1):2-10.
  7. Schachar JL, Zampolin RL, Miller TS, Farinhas JM, Freeman K, Taragin BH. External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center. Pediatr Radiol. 2011;41(8):971-9.
  8. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8.
  9. Smits M, Dippel DW, De haan GG, Dekker HM, Vos PE, Kool DR, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519-25.
  10. Mata-mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, et al. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary referral hospital in Japan. Springerplus. 2016;5:176.
  11. Bouida W, Marghli S, Souissi S, Ksibi H, Methammem M, Haguiga H, et al. Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Ann Emerg Med. 2013;61(5):521-7.