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Canadian Computed Tomography (CT) Head Rule Study

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00993252
Recruitment Status : Completed
First Posted : October 12, 2009
Last Update Posted : October 15, 2010
Canadian Institutes of Health Research (CIHR)
Information provided by:
Ottawa Hospital Research Institute

Brief Summary:
Each year, Canadian emergency department physicians treat 600,000 patients with head injury. Many of these are adults with "minor head injury", i.e. loss of consciousness or amnesia and a Glasgow Coma Scale (GCS) score of 13-15. Only 6.2% of these "minor" patients have some acute injury on computed tomography (CT scan) and only 0.5% have an epidural hematoma requiring surgery. Among Canadian teaching hospital emergency departments, we have shown a fourfold variation in use of CT and that a small but important number of intracranial hematomas are missed at the first visit.

Condition or disease Intervention/treatment Phase
Head Injury Procedure: CT Scan Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 4531 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Evaluation of an Active Strategy to Implement the Canadian CT Head Rule: Phase III
Study Start Date : September 2003
Actual Primary Completion Date : January 2009
Actual Study Completion Date : March 2009

Resource links provided by the National Library of Medicine

Intervention Details:
  • Procedure: CT Scan
    CT scan

Primary Outcome Measures :
  1. Computed tomography ordering proportions [ Time Frame: January 2009 ]

Secondary Outcome Measures :
  1. Number of missed CTs [ Time Frame: January 2009 ]
  2. Number of serious adverse outcomes [ Time Frame: January 2009 ]
  3. Length of stay in emergency department (ED) [ Time Frame: January 2009 ]
  4. Patient satisfaction [ Time Frame: January 2009 ]
  5. Sustainability of the intervention [ Time Frame: January 2009 ]
  6. Performance of the Canadian CT Head Rule [ Time Frame: January 2009 ]
  7. Economic evaluation measures [ Time Frame: January 2009 ]

Information from the National Library of Medicine

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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

Consecutive adult patients presenting to one of the study hospital EDs after sustaining acute minor head injury will be enrolled into the study. Eligibility as an 'acute minor head injury' case will be determined by the patient having all of the following characteristics upon arrival in the ED.

  1. Blunt trauma to the head resulting in witnessed loss of consciousness, definite amnesia, or witnessed disorientation, no matter how brief; this may be determined from the patient or from the report of a witness (the patient will be asked specific questions: 'do you remember the accident?', 'how did you get to the hospital?', 'have you talked to me before?').
  2. Initial ED GCS score of 13 or greater as ascertained by the attending physician (e.g. opens eyes spontaneously, obeys commands, but speech may include only comprehensible but inappropriate words).
  3. Injury within the past 24 hours.

Exclusion Criteria:

  1. less than 16 years,
  2. 'minimal' head injury i.e. no loss of consciousness, amnesia, or disorientation,
  3. no clear history of trauma as the primary event (for example primary seizure or syncope),
  4. GCS score of less than 13,
  5. head injury occurred more than 24 hours previously,
  6. obvious penetrating skull injury or depressed fracture,
  7. acute focal neurological deficit (motor or cranial nerve) that cannot be ascribed to an extracerebral cause, for example, traumatic mydriasis or peripheral neuropathy,
  8. have suffered a seizure prior to assessment in the ED,
  9. a bleeding disorder or current use of oral anticoagulants,125 or
  10. returned for reassessment of the same head injury

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00993252

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Canada, Alberta
University of Alberta
Edmonton, Alberta, Canada, T6G 2B7
Canada, British Columbia
Vancouver General Hospital
Vancouver, British Columbia, Canada, V5Z 1M9
Royal Columbian Hospital
Westminster, British Columbia, Canada, V3L 3W7
Canada, Ontario
St. Thomas Hospital
Elgin, Ontario, Canada
Kingston General Hospital
Kingston, Ontario, Canada, K7L 2V7
London Health Sciences Centre
London, Ontario, Canada, N6A 4G5
The Ottawa Hospital Civic Campus
Ottawa, Ontario, Canada, K1Y 4E9
The Ottawa Hospital
Ottawa, Ontario, Canada, K1Y 4E9
Sunnybrook and Women's College HSC
Toronto, Ontario, Canada, M4N 3M5
Credit Valley Hospital
Toronto, Ontario, Canada
Sponsors and Collaborators
Ottawa Hospital Research Institute
Canadian Institutes of Health Research (CIHR)
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Principal Investigator: Ian G Stiell, MD MSc University of Ottawa
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Dr. Ian Stiell, OHRI Identifier: NCT00993252    
Other Study ID Numbers: 42521
First Posted: October 12, 2009    Key Record Dates
Last Update Posted: October 15, 2010
Last Verified: October 2010
Keywords provided by Ottawa Hospital Research Institute:
head injury
clinical impact
Additional relevant MeSH terms:
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Craniocerebral Trauma
Trauma, Nervous System
Nervous System Diseases
Wounds and Injuries