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The New Orleans criteria for head injury is a tool designed to help determine whether a head computed tomography (CT) scan is necessary following a head injury. It evaluates seven specific conditions that a patient may present with after a head trauma. Each condition is assessed and scored to derive a final score that guides the need for further imaging.

Here's how the process works:

- Evaluate the presence of the following seven conditions:
  - Headache
  - Vomiting
  - Age > 60
  - Drug or alcohol intoxication
  - Short-term memory deficits
  - Physical evidence of trauma above the clavicles
  - Seizure

For each of these conditions, assign a score of 1 if the condition is present (true) and a score of 0 if it is not (false). The scores for each condition are then summed to obtain a total score, which ranges from 0 to 7.

Interpretation of the total score is straightforward:
- A total score of 0 suggests that there is no need for a head CT scan. This outcome indicates a low risk of significant injury, as none of the concerning conditions are present.
- Any score greater than 0 (from 1 to 7) indicates that a head CT scan should be considered. Each affirmative condition increases the potential risk for a significant head injury, and imaging may thus be warranted to rule out complications.

This scoring system aids in clinical decision-making by weighing specific risk factors associated with head injuries, providing a systematic approach for assessing the urgency of further diagnostic imaging.

The New Orleans Criteria (NOC) is a clinical decision rule used to determine which patients with head injury require a computed tomography (CT) scan. This calculator is specifically applicable to patients who have experienced minor head injury, defined as a history of loss of consciousness or amnesia and a Glasgow Coma Scale (GCS) score of 15.

The clinical utility of the New Orleans Criteria is to help clinicians decide whether to perform a CT scan in patients with minor head injury, thereby reducing unnecessary radiation exposure and healthcare costs. The criteria include factors such as headache, vomiting, age over 60, drug or alcohol intoxication, persistent anterograde amnesia, visible trauma above the clavicles, and seizure.

Exclusion criteria for the use of the New Orleans Criteria include patients with severe head injury (GCS score less than 15), patients with obvious indications for a CT scan (such as focal neurological deficits), and patients who are on blood thinners or have a bleeding disorder.

New Orleans criteria for head injury

The Pediatric Emergency Care Applied Research Network (PECARN) algorithm assesses the risk of a clinically important traumatic brain injury in children who have sustained head injuries. This is achieved through evaluating a set of six specific factors and quantifying them into a score.

The factors considered are:
- Altered mental status
- Occipital, parietal, or temporal scalp hematoma
- Loss of consciousness for 5 seconds or more
- Severe mechanism of injury
- Palpable or unclear skull fracture
- Not acting normally according to a parent

Each factor is assessed with a simple true or false evaluation. If the condition is present (true), it contributes 1 point to the overall score. Conversely, if the condition is absent (false), it contributes 0 points. The calculator sums these points to derive a total score, which can range from 0 to 6.

The interpretation of the score is straightforward:
- A score of 0 suggests that a clinically significant traumatic brain injury is unlikely.
- A score of 1 or more indicates that there is a likelihood of a clinically significant traumatic brain injury.

This simple yet effective scoring system aids in determining the necessity for further medical evaluation and intervention.

The Pediatric Emergency Care Applied Research Network (PECARN) algorithm for head injury is a clinical decision-making tool used in the pediatric population. It is specifically designed to assist healthcare providers in the emergency department to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) who do not require a computed tomography (CT) scan after head trauma. The PECARN algorithm stratifies risk based on factors such as the mechanism of injury, symptoms like vomiting and headache, and signs like loss of consciousness or not acting normally according to the parents. 

The clinical utility of the PECARN algorithm is to reduce unnecessary radiation exposure from CT scans in children with minor head injuries, while still accurately identifying those with significant injuries. 

The PECARN algorithm should not be used in children with severe mechanism of injury, such as a motor vehicle crash with ejection, death of another passenger, or rollover; a fall of more than 5 feet; or being hit by a high-impact object. It also should not be used in children with obvious signs of severe injury, such as a Glasgow Coma Scale (GCS) score of less than 15, signs of skull fracture, or altered mental status.

Pediatric Emergency Care Applied Research Network algorithm for head injury (PECARN algorithm)

The Canadian CT Head Rule (CCHR) assists healthcare providers in deciding whether a head CT scan is warranted for a patient who has suffered head trauma. It operates based on evaluating specific exclusion, high-risk, and medium-risk criteria.

Initially, consider the exclusion criteria. If the patient is under 16 years, taking blood thinners, or had a seizure after the injury, they are not eligible for CCHR. In such cases, the rule doesn't apply, and the result indicates that the patient is not eligible.

If the patient is eligible, assess the high-risk criteria. These include:

- Glasgow Coma Scale (GCS) score under 15 two hours after the injury
- Suspected open or depressed skull fracture
- Signs of basilar skull fracture, such as:
  - Hemotympanum
  - Raccoon eyes
  - CSF otorrhea or rhinorrhea
  - Battle's sign
- More than one episode of vomiting
- Age 65 years or older

The presence of any of these high-risk factors suggests that a head CT might be necessary.

If none of the high-risk criteria are present, evaluate the medium-risk criteria. These involve:

- Amnesia regarding events over 30 minutes before the injury
- A significant mechanism of injury, such as:
  - Pedestrian hit by a vehicle
  - Occupant ejected from a vehicle
  - Fall from a height greater than 3 feet or down more than 5 stairs

If any medium-risk criteria are met, a head CT should also be considered.

When the patient does not meet any of the specified criteria—exclusion, high-risk, or medium-risk—a CT scan is likely unnecessary. This conclusion assists healthcare providers in identifying patients who require imaging and those who do not, thereby optimizing resource use and ensuring patient safety.

The Canadian CT Head Rule (CCHR) is a clinical decision-making tool designed for use in adult patients who have sustained a minor head injury. The CCHR helps clinicians determine which patients require a computed tomography (CT) scan to rule out clinically significant brain injuries, including fractures and intracranial hemorrhages. The rule is intended to reduce unnecessary radiation exposure and healthcare costs associated with CT scans. 

The CCHR applies to patients who have experienced a minor head injury, defined as a Glasgow Coma Scale (GCS) score of 13-15 after witnessed loss of consciousness, amnesia, or disorientation. It is not applicable to patients who are under 16 years old, have a seizure after injury, are on anticoagulant therapy, have a known brain tumor, or have a history of neurosurgery.

Canadian CT head rule (CCHR)

The Canadian Assessment of Tomography for Childhood Head injury rule (CATCH rule) assists in assessing the level of risk associated with a child's head injury to determine the potential need for a CT scan. It evaluates specific factors that could suggest a significant brain injury, categorizing the risk into low, medium, or high.

You need to answer seven questions with either "Yes" or "No":

- GCS < 15 at 2 hours after injury
- Suspected open or depressed skull fracture
- History of worsening headache
- Irritability on examination
- Any sign of basal skull fracture
- Large boggy scalp hematoma
- Dangerous mechanism of injury

Here’s how the risk is interpreted based on these responses:

- High risk: If any of these conditions are true, it indicates a high possibility of significant head injury, necessitating immediate imaging and medical evaluation:
  - GCS < 15 at 2 hours after injury
  - Suspected open or depressed skull fracture
  - History of worsening headache
  - Irritability on examination

- Medium risk: This suggests a moderate probability of brain injury, which may need further observation or imaging, if any of the following are true:
  - Any sign of basal skull fracture
  - Large boggy scalp hematoma
  - Dangerous mechanism of injury

- Low risk: If all the assessment questions yield a "No," it indicates a low likelihood of significant brain injury, suggesting that a CT scan may not be necessary.

By answering these questions, the rule helps identify children who might require just observation and those who would benefit from further diagnostic imaging to prevent unnecessary scans and interventions.

The Canadian Assessment of Tomography for Childhood Head injury rule, or CATCH rule, is a clinical calculator used in the pediatric population, specifically for children with minor head injuries. This scoring system is designed to help clinicians determine which children require a computed tomography (CT) scan to rule out clinically important traumatic brain injury (ciTBI). The CATCH rule includes factors such as age, mechanism of injury, and clinical symptoms to stratify the risk of ciTBI. The clinical utility of this calculator is to reduce unnecessary radiation exposure from CT scans in children with minor head injuries, while still identifying those at risk for significant injury. The CATCH rule should not be used in children with severe injury, those with a Glasgow Coma Scale score of less than 13, or those with known brain pathology.

Canadian Assessment of Tomography for Childhood Head injury rule (CATCH rule)

The Simplified Motor Score (SMS) for traumatic brain injury (TBI) is designed to evaluate the likelihood of a severe TBI based on a patient's motor response. The tool takes a single input regarding the patient's response to stimuli and assigns a numerical score between 0 and 2, which is then used to interpret the severity of the brain injury.

The input requires selecting one of the following patient responses:
- Obeys commands
- Localizes pain
- Withdrawals to pain or worse

Each response is assigned a specific score according to the following scale:

| Patient Response                | Score |
|---------------------------------|-------|
| Obeys commands                  | 2     |
| Localizes pain                  | 1     |
| Withdrawals to pain or worse    | 0     |

To compute the output, the selected patient response is matched to its corresponding score. This score is then used to determine an interpretation regarding the severity of TBI:

- If the score is 0 or 1, the patient is likely suffering from a severe traumatic brain injury. This is interpreted as "Severe traumatic brain injury is likely."
- If the score is 2, severe traumatic brain injury is not considered likely. This is interpreted as "Severe traumatic brain injury is not likely."

The Simplified Motor Score (SMS) is a clinical calculator used in the assessment of patients with traumatic brain injury (TBI). It is a simplified version of the Glasgow Coma Scale (GCS), focusing solely on the motor response component. The SMS is used to predict the need for neurosurgical intervention and the likelihood of survival following TBI. 

The patient population for the SMS includes individuals who have experienced a traumatic brain injury. This can range from mild concussions to severe brain damage, often resulting from incidents such as falls, vehicle accidents, or violence. 

The clinical utility of the SMS is its simplicity and ease of use, especially in emergency settings where a quick assessment is crucial. It helps clinicians to rapidly stratify the severity of TBI, guide treatment decisions, and provide prognostic information. 

The SMS may not be applicable or accurate in patients with pre-existing neurological disorders, those under the influence of drugs or alcohol, or those with other injuries that could affect motor response. It is also less detailed than the full GCS, and therefore may not capture the full extent of a patient's neurological impairment.

Simplified Motor Score for traumatic brain injury (SMS)

The Glasgow Coma Scale (GCS) is a tool used to assess a person's level of consciousness. It evaluates three responses: eye opening, verbal, and motor. Each response is scored based on predefined criteria, and the total GCS score ranges from 3 to 15: 

Eye Opening Response:
- Spontaneously: 4 points
- To verbal command: 3 points
- To pain: 2 points
- No response: 1 point

Verbal Response:
- Oriented: 5 points
- Confused: 4 points
- Inappropriate words: 3 points
- Incomprehensible sounds: 2 points
- No verbal response: 1 point

Motor Response:
- Obeys commands: 6 points
- Purposeful movement to painful stimulus: 5 points
- Withdraws in response to pain: 4 points
- Flexion in response to pain: 3 points
- Extension response in response to pain: 2 points
- No motor response: 1 point

To determine the GCS score, collect the patient's responses across these three categories. Assign the corresponding numerical score for each response, then sum them to get the total score. The total score indicates the level of consciousness:

- A score of 3 suggests deep unconsciousness or severe impairment.
- Scores from 4 to 15 indicate ascending levels of consciousness, with lower scores signifying more serious unconscious states.
- Scores between 13 and 15 indicate full consciousness or only mild impairment.

By organizing the patient responses, converting them to numerical values, summing the totals, and analyzing the score range, one can interpret the patient's state of consciousness based on the GCS.

The Glasgow Coma Scale (GCS) is a clinical calculator used to assess the level of consciousness in patients, particularly those with traumatic brain injury. It is applicable to a wide range of patient populations, including both adults and children, and is used in various clinical settings such as emergency departments, intensive care units, and general wards. 

The GCS evaluates three aspects of a patient's responsiveness: eye opening, verbal response, and motor response. Each aspect is scored separately, and the scores are then summed to give a total GCS score ranging from 3 (indicating deep unconsciousness) to 15 (indicating full consciousness). 

The GCS is a valuable tool for initial and ongoing assessment of a patient's neurological status, and it helps guide treatment decisions and prognostication. It is also widely used in clinical research and for benchmarking the quality of care for patients with brain injury.

There are no specific exclusion criteria for the use of the GCS. However, it may be less accurate or not applicable in patients with certain conditions that can affect consciousness or the ability to respond, such as intoxication, hypothermia, or severe facial trauma. It is also less useful in intubated patients, as their verbal response cannot be assessed.

Glasgow Coma Scale (GCS)

The CHALICE risk score is a tool used to assess the need for a CT scan in children who have sustained a head injury. This assessment is based on a list of specific clinical signs or circumstances that may indicate a higher risk of a significant injury. The evaluation considers whether any one of these predefined conditions is present.

The conditions that suggest the child may not be at low risk, and therefore a CT scan should be considered, include:

- Witnessed loss of consciousness exceeding 5 minutes.
- Amnesia, either antegrade or retrograde, lasting more than 5 minutes.
- Abnormal drowsiness that surpasses expectations for the situation, as judged by a doctor.
- Three or more episodes of vomiting following the head injury.
- Any suspicion of non-accidental injury by the examining doctor.
- A post-injury seizure in a child with no previous history of epilepsy.
- A Glasgow Coma Score of less than 14, or less than 15 if the child is under 1 year old.
- Suspicion of a penetrating or depressed skull injury, or a tense fontanelle.
- Indicators of a basal skull fracture such as blood or cerebrospinal fluid leakage from the ear or nose, panda eyes, Battle's sign, hemotympanum, facial crepitus, or a serious facial injury.
- Any positive focal neurologic sign indicating abnormalities in motor, sensory, coordination, or reflex responses.
- Bruising, swelling, or laceration greater than 5 cm if the child is under 1 year old.
- Involvement in a high-speed road traffic accident, defined as one with speeds over 64 km/h (40 mph), in the capacity of a pedestrian, cyclist, or vehicle occupant.
- A fall from a height exceeding 3 meters.
- An injury sustained from a high-speed projectile or other objects.

The presence of any of these conditions warrants the consideration for a CT scan with the conclusion that the child is "not low risk." On the other hand, if none of these conditions are present, the child is deemed to be at "low risk" and a CT scan is typically considered unnecessary. This systematic approach helps prioritize the use of CT scans, focusing on children who exhibit signs that may indicate a more severe head injury.

The CHALICE risk score, or Children's Head injury Algorithm for the prediction of Important Clinical Events, is a clinical calculator used in the pediatric population. It is specifically designed to assess the risk of significant head injuries in children following a traumatic event. The CHALICE risk score helps clinicians decide whether a child requires a head CT scan after a head injury, thereby aiding in the diagnosis and management of potential intracranial injuries. It takes into account factors such as the mechanism of injury, clinical signs and symptoms, and the child's age. This calculator should not be used in children with trivial head injuries, those with clear indications for immediate neuroimaging, or those with pre-existing neurological disorders.

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