Article Figures & Data
Tables
Clinical condition—head trauma
CT, head, without contrast MRI, brain, without contrast X-ray and/or CT, cervical spine† CT, head, without and with contrast MRI, brain, without and with contrast CTA, head and neck MRA, head and neck Angiography, cerebral X-ray, skull Minor or mild acute closed head injury (GCS ≥13), without risk factors or neurologic deficit 7a 4 5 3 2 3b 3b 1 1 Minor or mild acute closed head injury, focal neurologic deficit and/or risk factors 9 6c 6 2 3 5cd 5cd 1 1 Moderate or severe acute closed head injury 9 6 8 2 2 5 5 1 2 Mild or moderate acute closed head injury, child <2 years old 9 7e 7 2 4f 4d 4d 1 5 Subacute or chronic closed head injury with cognitive and/or neurologic deficit(s)g 6 8 2h 2 3 4i 4i 1 2 Closed head injury; rule out carotid or vertebral artery dissection‡ 8 8e 5 6j 6 8 8k 6c 2 Penetrating injury, stable, neurologically intact 9 5l 8m 4j 4l 7 6l 5d 8n Skull fracture 9 6l 6 4 4lo 7d 4l 1 5i Note:—Appropriateness criteria scale from 1 to 9; 1 indicates least appropriate; 9, most appropriate;
a , known to be low yield;
b , rarely indicated with mild trauma;
c , for problem solving;
d , if vascular injury suspected;
e , include diffusion-weighted images;
f , potentially useful in suspected non-accidental trauma;
g , PET or SPECT for brain = 4–used for selected cases;
h , assuming there are no spinal neurologic deficits;
i , for selected cases;
j consider perfusion;
k , add T1 images;
l , if MRI is safe;
m , if neck or C-spine is site of injury;
n , if calvarium is site of injury;
o , useful if infection is suspected.
† , see the ACR Appropriateness Criteria on Spine Trauma;
‡ , see the ACR Appropriateness Criteria on Cerebrovascular Disease.
