CT, head, without contrast | MRI, brain, without contrast | X-ray and/or CT, cervical spine† | CT, head, without and with contrast | MRI, brain, without and with contrast | CTA, head and neck | MRA, head and neck | Angiography, cerebral | X-ray, skull | |
---|---|---|---|---|---|---|---|---|---|
Minor or mild acute closed head injury (GCS ≥13), without risk factors or neurologic deficit | 7a | 4 | 5 | 3 | 2 | 3b | 3b | 1 | 1 |
Minor or mild acute closed head injury, focal neurologic deficit and/or risk factors | 9 | 6c | 6 | 2 | 3 | 5cd | 5cd | 1 | 1 |
Moderate or severe acute closed head injury | 9 | 6 | 8 | 2 | 2 | 5 | 5 | 1 | 2 |
Mild or moderate acute closed head injury, child <2 years old | 9 | 7e | 7 | 2 | 4f | 4d | 4d | 1 | 5 |
Subacute or chronic closed head injury with cognitive and/or neurologic deficit(s)g | 6 | 8 | 2h | 2 | 3 | 4i | 4i | 1 | 2 |
Closed head injury; rule out carotid or vertebral artery dissection‡ | 8 | 8e | 5 | 6j | 6 | 8 | 8k | 6c | 2 |
Penetrating injury, stable, neurologically intact | 9 | 5l | 8m | 4j | 4l | 7 | 6l | 5d | 8n |
Skull fracture | 9 | 6l | 6 | 4 | 4lo | 7d | 4l | 1 | 5i |
Note:—Appropriateness criteria scale from 1 to 9; 1 indicates least appropriate; 9, most appropriate;
a , known to be low yield;
b , rarely indicated with mild trauma;
c , for problem solving;
d , if vascular injury suspected;
e , include diffusion-weighted images;
f , potentially useful in suspected non-accidental trauma;
g , PET or SPECT for brain = 4–used for selected cases;
h , assuming there are no spinal neurologic deficits;
i , for selected cases;
j consider perfusion;
k , add T1 images;
l , if MRI is safe;
m , if neck or C-spine is site of injury;
n , if calvarium is site of injury;
o , useful if infection is suspected.
† , see the ACR Appropriateness Criteria on Spine Trauma;
‡ , see the ACR Appropriateness Criteria on Cerebrovascular Disease.