ACR Appropriateness Criteria Head Trauma.
Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
St Louis University Hospital, St Louis, Missouri. Electronic address: vshetty@slu.edu.
Vilaas S
VS
Shetty
St Louis University School of Medicine, St Louis, Missouri.
Martin N
MN
Reis
Vanderbilt University, Nashville, Tennessee.
Joseph M
JM
Aulino
Chesapeake Medical Imaging, Annapolis, Maryland.
Kevin L
KL
Berger
Duke University Division of Emergency Medicine, Cary, North Carolina, American College of Emergency Physicians.
Joshua
J
Broder
Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
Asim F
AF
Choudhri
Emory University Hospital, Atlanta, Georgia.
A Tuba
AT
Kendi
University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Marcus M
MM
Kessler
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Claudia F
CF
Kirsch
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Michael D
MD
Luttrull
Dent Neurologic Institute, Amherst, New York, American Academy of Neurology.
Laszlo L
LL
Mechtler
Littleton Adventist Hospital, Littleton, Colorado.
J Adair
JA
Prall
Rush University, Chicago, Illinois.
Patricia B
PB
Raksin
Duke University Medical Center, Durham, North Carolina.
Christopher J
CJ
Roth
Mallinckrodt Institute of Radiology, St Louis, Missouri.
Aseem
A
Sharma
University of Texas at Houston, Houston, Texas.
O Clark
OC
West
Stanford Medical Center, Stanford, California.
Max
M
Wintermark
University of Cincinnati Medical Center, Cincinnati, Ohio.
Rebecca S
RS
Cornelius
University of California, San Diego, Health Center, San Diego, California.
Julie
J
Bykowski
D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D019317:Evidence-Based Medicine; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D059906:Neuroimaging / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000592:standards
Appropriateness Criteria; cerebrospinal fluid leak; head trauma; neuroimaging; traumatic brain injury; vascular