Approximately 1 million patients with minor head injury are evaluated
in US emergency departments and primary care offices annually.1,2 Less
than 10% of patients with a normal level of consciousness after minor head
trauma have intracranial injury and less than 1% require neurosurgical intervention.3- 5 The goal of identifying
the few patients with intracranial injury after minor head trauma has led
to 2 approaches to computed tomography (CT) use in the United States: routinely
scanning all patients with head trauma and loss of consciousness or reliance
on clinical judgment to guide in CT use. Routine scanning results in large
health care expenditures, whereas reliance on clinical judgment could reduce
CT use, but at the cost of missing 20% of patients with intracranial injury.6,7
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