Implementation of a guideline for computed tomography head imaging in head injury: A prospective study

Christina Fong*, Winston Chong, Elmer Villaneuva, Ahuva Yocheved Segal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objective: To improve appropriate ordering of head computed tomography (CT) in patients presenting with a head injury by applying an evidence-based head injury guideline. Methods: This was a comparison observational study of CT head ordering in the setting of head trauma between two groups of patients. There was a pre-guideline implementation group and a post-guideline implementation group. Our Southernhealth Head Injury Guideline was largely based on the Canadian CT Head Rule by Steill et al. 2001.We also applied the Canadian CT Head Rule to our post-guideline implementation group. Results: CT ordering rate in the pre-guideline group was 31.6% compared with 59% in the post-guideline group with a relative risk of 1.88 (95% confidence interval [CI]: 1.56-2.27). Abnormal head CT were reported in 6.8% in the pre-guideline group and 5% in the post-guideline group (relative risk 0.88, 95% CI 0.44-1.51). When we applied the Canadian CT Head Rule to the prospective group, four patients with clinically significant abnormal head CT would not have been scanned. The sensitivity of the guideline was 100% (95% CI 79-100%), with a specificity of 43.22% (95% CI 37-48%) in diagnosing a significant head injury on CT. Conclusion: The Southernhealth Head Injury Guideline is safe and easy to apply to minor and major head injuries.

Original languageEnglish
Pages (from-to)410-419
Number of pages10
JournalEMA - Emergency Medicine Australasia
Issue number5
Publication statusPublished - Oct 2008


  • Brain injury
  • Computed tomography head rules
  • Guideline
  • Head computed tomography
  • Head injury


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