New Orleans Charity Head Trauma/Injury Rule
Notes:
- This rule applies only to patients with GCS 15 who have had loss of consciousness
- Persistent anterograde amnesia refers to deficits in short-term memory
- Visible trauma includes contusions, abrasions, lacerations, or other evidence of injury
- If any one criterion is present, CT scan is recommended
About the New Orleans Criteria
The New Orleans Criteria is a clinical decision rule used to determine which patients with minor head injury need CT scanning. It was developed to identify patients at risk for intracranial injury after minor head trauma.
Clinical Significance
The New Orleans Criteria helps clinicians identify patients with minor head trauma who are at risk for intracranial injury and require CT scanning, while potentially reducing unnecessary imaging in low-risk patients.
When to Use
Use this rule for patients with minor head injury who:
- Have a Glasgow Coma Scale (GCS) score of 15
- Had loss of consciousness or amnesia for the traumatic event
- Presented within 24 hours of the injury
Limitations
- Not applicable to patients with GCS < 15
- Not validated in children under 18 years
- Not applicable to patients on anticoagulants or with bleeding disorders
- May lead to higher CT utilization compared to other decision rules
Evidence Base
The New Orleans Criteria was derived from a prospective study of 520 patients with minor head injury. It has a sensitivity of 100% for detecting clinically significant brain injuries, but a lower specificity compared to other decision rules like the Canadian CT Head Rule.
References
- Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-105.
- Smits M, Dippel DW, de Haan GG, 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):1519-1525.
- Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-1396.