We should stop using the Canadian CT head rule - First10EM

(Finnerty 2015) However, if that is the case, why are so many people still using the Canadian CT Head rule more than a decade after the publication of an implementation study demonstrating no benefit, and possible harm?

Stiell IG, Clement CM, Grimshaw JM, Brison RJ, Rowe BH, Lee JS, Shah A, Brehaut J, Holroyd BR, Schull MJ, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, Macphail I, Ross S, Perry JJ, Ip U, Lesiuk H, Bennett C, Wells GA. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments.

Stable adult patients presenting to the emergency department after minor head injury with all of the following: “blunt trauma to the head resulting in witnessed loss of consciousness, amnesia or witnessed disorientation, an initial Glasgow Coma Scale score of 13 or greater, and occurrence of the injury within the previous 24 hours.”

(Stiell 2001) In the minds of the researchers, no one would be crazy enough to even consider a CT scan in a patient who hadn’t lost consciousness, had amnesia, or had clear disorientation.

Finnerty NM, Rodriguez RM, Carpenter CR, Sun BC, Theyyunni N, Ohle R, Dodd KW, Schoenfeld EM, Elm KD, Kline JA, Holmes JF, Kuppermann N. Clinical Decision Rules for Diagnostic Imaging in the Emergency Department: A Research Agenda.

Stiell IG, Clement CM, Grimshaw JM, Brison RJ, Rowe BH, Lee JS, Shah A, Brehaut J, Holroyd BR, Schull MJ, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, Macphail I, Ross S, Perry JJ, Ip U, Lesiuk H, Bennett C, Wells GA. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments.