Clinical condition—head trauma

CT, head, without contrastMRI, brain, without contrastX-ray and/or CT, cervical spineCT, head, without and with contrastMRI, brain, without and with contrastCTA, head and neckMRA, head and neckAngiography, cerebralX-ray, skull
Minor or mild acute closed head injury (GCS ≥13), without risk factors or neurologic deficit7a45323b3b11
Minor or mild acute closed head injury, focal neurologic deficit and/or risk factors96c6235cd5cd11
Moderate or severe acute closed head injury968225512
Mild or moderate acute closed head injury, child <2 years old97e724f4d4d15
Subacute or chronic closed head injury with cognitive and/or neurologic deficit(s)g682h234i4i12
Closed head injury; rule out carotid or vertebral artery dissection88e56j688k6c2
Penetrating injury, stable, neurologically intact95l8m4j4l76l5d8n
Skull fracture96l644lo7d4l15i
  • 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.