ACR Appropriateness Criteria® Head Trauma: 2021 Update

Expert Panel on Neurological Imaging; Robert Y Shih¹, Judah Burns², Amna A Ajam³, Joshua S Broder⁴, Santanu Chakraborty⁵, A Tuba Kendi⁶, Mary E Lacy⁷, Luke N Ledbetter⁸, Ryan K Lee⁹, David S Liebeskind¹⁰, Jeffrey M Pollock¹¹, J Adair Prall¹², Thomas Ptak¹³, P B Raksin¹⁴, Matthew D Shaines¹⁵, A John Tsiouris¹⁶, Pallavi S Utukuri¹⁷, Lily L Wang¹⁸, Amanda S Corey¹⁹

Affiliations

¹ Uniformed Services University, Bethesda, Maryland. Electronic address: robert.shih@us.army.mil.
² Panel Chair, Montefiore Medical Center, Bronx, New York.
³ Ohio State University, Columbus, Ohio.
⁴ Duke University School of Medicine, Durham, North Carolina, American College of Emergency Physicians, Residency Program Director for Emergency Medicine, Vice Chief for Education, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine.
⁵ Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists, CAR representative in ACR Quality Commission.
⁶ Mayo Clinic, Rochester, Minnesota, Head of Nuclear Medicine Therapies at Mayo Clinic.
⁷ University of New Mexico, Albuquerque, New Mexico, American College of Physicians.
⁸ University of California Los Angeles, Los Angeles, California.
⁹ Einstein Healthcare Network, Philadelphia, Pennsylvania.
¹⁰ University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN.
¹¹ Oregon Health and Science University, Portland, Oregon, Editor, ACR Case in Point; Functional MRI Director, Oregon Health and Science University.
¹² Littleton Adventist Hospital, Littleton, Colorado, Neurosurgery expert, Chair, Guidelines Committee, Joint Section for Trauma and Critical Care.
¹³ R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, Vice Chair of Community Radiology, University of Maryland Medical Center, Chief of Emergency and Trauma Imaging, R Adams Cowley Shock Trauma Center.
¹⁴ John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, Neurosurgery expert, Chair Elect, American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma & Neurocritical Care; Vice Chair, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee; Director, Neurosurgery ICU.
¹⁵ Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Internal Medicine Physician, Associate Program Director for the Moses-Weiler Internal Medicine Residency Program, Albert Einstein College of Medicine; Associate Chief, Division of Hospital Medicine.
¹⁶ Weill Cornell Medicine, New York, New York.
¹⁷ Columbia University Medical Center, New York, New York.
¹⁸ University of Cincinnati Medical Center, Cincinnati, Ohio, Neuroradiology Fellowship Program Director.
¹⁹ Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

PMID: 33958108
DOI: 10.1016/j.jacr.2021.01.006

Practice Guideline

ACR Appropriateness Criteria® Head Trauma: 2021 Update

Expert Panel on Neurological Imaging et al. J Am Coll Radiol. 2021 May.

. 2021 May;18(5S):S13-S36.

doi: 10.1016/j.jacr.2021.01.006.

Authors

Affiliations

¹ Uniformed Services University, Bethesda, Maryland. Electronic address: robert.shih@us.army.mil.
² Panel Chair, Montefiore Medical Center, Bronx, New York.
³ Ohio State University, Columbus, Ohio.
⁴ Duke University School of Medicine, Durham, North Carolina, American College of Emergency Physicians, Residency Program Director for Emergency Medicine, Vice Chief for Education, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine.
⁵ Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists, CAR representative in ACR Quality Commission.
⁶ Mayo Clinic, Rochester, Minnesota, Head of Nuclear Medicine Therapies at Mayo Clinic.
⁷ University of New Mexico, Albuquerque, New Mexico, American College of Physicians.
⁸ University of California Los Angeles, Los Angeles, California.
⁹ Einstein Healthcare Network, Philadelphia, Pennsylvania.
¹⁰ University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN.
¹¹ Oregon Health and Science University, Portland, Oregon, Editor, ACR Case in Point; Functional MRI Director, Oregon Health and Science University.
¹² Littleton Adventist Hospital, Littleton, Colorado, Neurosurgery expert, Chair, Guidelines Committee, Joint Section for Trauma and Critical Care.
¹³ R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, Vice Chair of Community Radiology, University of Maryland Medical Center, Chief of Emergency and Trauma Imaging, R Adams Cowley Shock Trauma Center.
¹⁴ John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, Neurosurgery expert, Chair Elect, American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma & Neurocritical Care; Vice Chair, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee; Director, Neurosurgery ICU.
¹⁵ Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Internal Medicine Physician, Associate Program Director for the Moses-Weiler Internal Medicine Residency Program, Albert Einstein College of Medicine; Associate Chief, Division of Hospital Medicine.
¹⁶ Weill Cornell Medicine, New York, New York.
¹⁷ Columbia University Medical Center, New York, New York.
¹⁸ University of Cincinnati Medical Center, Cincinnati, Ohio, Neuroradiology Fellowship Program Director.
¹⁹ Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

PMID: 33958108
DOI: 10.1016/j.jacr.2021.01.006

Abstract

Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, head trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Appropriate Use Criteria; Appropriateness Criteria; CT; Head trauma; MRI; Traumatic brain injury.

Published by Elsevier Inc.

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ACR Appropriateness Criteria® Head Trauma: 2021 Update

Affiliations

ACR Appropriateness Criteria® Head Trauma: 2021 Update

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