Head Injuries in Rural Areas the Canadian CT Rule and New Orleans Criteria

Concussion

The complex issue of providing adequate care and preventative testing to a population that is increasingly unable to afford the rising expenses associated with such care remains a substantial problem in the United States, and directly impacts care provided for cases of head traumas in rural areas. The Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) are two clinical decision making methods for determining when the expense of a CT scan is warranted following a head trauma, though indications for the use of either testing procedure differ. Despite widespread and successful use elsewhere, the CCHR is not widely used in the United States and is especially under-utilized in rural areas, leading to rising expenses and the mistreatment of traumatic head injuries. Equipment shortages and other facility limitations in rural hospitals and clinics further complicates treatment for head injuries, and sheer geographic distance to facilities means that many victims of head injuries will never seek the appropriate care for their injury.

Research clearly shows that a stricter application of established clinical decision-making tests such as the CCHR and the NOC could greatly increase both the efficacy and the cost efficiency of care provided following traumatic head injuries. The CCHR is a more effective tool for anticipating a need for neurosurgical mediation, but both tests are equally effective in discerning brain injury and in general sensitivity to the diagnosis of head trauma severity. The use of either test would significantly reduce the rate of image testing in head trauma patients without damaging the overall efficacy of treatment, leading to a more careful and medically indicated use of imaging procedures and a reduction of healthcare costs to patients, insurers, and facilities alike. The sensitivity and efficacy of the CCHR in particular has been demonstrated time and time again in a variety of populations by many different researchers, and is established as a best practice procedure in hospitals and other settings in Australia, Canada, and throughout much of Europe. The continued paucity of its use in the United States comes at the detriment of all involved in the healthcare system, and is especially egregious given the medical needs and other practical constraints of rural populations. In no piece of research examining either the NOC or the CCHR was wither clinical testing method found to under-estimate head trauma injury, and predictions of brain injury were confirmed with one-hundred percent sensitivity in many studies. That such decision-making tests should be utilized, and that the CCHR is often the most sensitive and appropriate means of decision-making in head trauma cases, is a matter of empirical certainty.