Investigation

Intracranial lesions can be detected radiologically before they produce clinical changes. Rather than awaiting neurological deterioration, early imaging reduces the delay in detection and treatment of acute traumatic intracranial injury and is reflected in better outcomes. Exclusion or demonstration of intracranial injury can also guide decisions about the intensity and duration of observation in less severe injuries.

There has been a progressive shift away from simple skull radiography as a source of circumstantial evidence of intracranial damage towards CT scanning to provide definitive data. In the absence of randomised comparisons of different investigative strategies, indications for imaging at presentation after TBI depend upon the likely yield in different categories of patient. Although most patients with minor head injury can be discharged without sequelae after a period of observation, in a small proportion their neurological condition deteriorates and requires neurosurgical intervention for intracranial haematoma. The objective of the Canadian CT Head Rule Study was to develop an accurate and reliable decision rule for the use of computed tomography (CT) in patients with minor head injury. Such a decision rule would allow physicians to be more selective in their use of CT without compromising the care of patients with minor head injury (Table 2.2).52

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