New Orleans/Charity Head Trauma/Injury Rule

Why did you develop the New Orleans/Charity Head Injury/Trauma Rule? Was there a clinical experience that inspired you to create this tool for clinicians?

As a resident at the University of Pittsburgh, I was convinced that CT was overused in patients with minor head injury (MHI). When I became faculty at Charity Hospital in New Orleans, I was much wiser and less cavalier, noting that occasionally some patients with MHI really did have badness on CT. But not very many, and usually it was quite unexpected. As a county hospital, we had little funds available for research, but I plied the residents with candy and ended up enrolling over 1,000 patients.

What pearls, pitfalls and/or tips do you have for users of the New Orleans/Charity Head Injury/Trauma Rule? Are there cases in which it has been applied, interpreted, or used inappropriately?

Users should be aware that the original data set only included patients with either loss of consciousness or post-traumatic amnesia, although subsequent studies have shown that the 'rule' is equally sensitive in patients without loss of consciousness. The mnemonic HEAD CT'S can be used to remember the seven criteria: headache, emesis, age over 60, drug or alcohol intoxication, convulsion, trauma visible above the clavicles, and short-term memory deficits. Several definitions are important when using this rule. Trauma visible above the clavicles implies any bruises, contusions or lacerations. Short-term memory deficits are defined as loss of anterograde amnesia, not the expected retrograde amnesia.

What recommendations do you have for health care providers once they have applied the New Orleans/Charity Head Injury/Trauma Rule? Are there any adjustments or updates you would make to the score given recent changes in medicine like imaging or the research we now have on concussion?

Clinical decision rules do not replace clinical judgment.

Micelle J. Haydel, MD, is the residency director of emergency medicine and associate professor of clinical medicine at Louisiana State University Health Sciences Center. She began her career in medicine as a nurse, completing her training at LSU School of Nursing and then later attended Tulane School of Medicine for her medical degree. Dr. Haydel currently researches head and facial injury/trauma.