Year: 2026 | Month: January | Volume: 16 | Issue: 1 | Pages: 298-313
DOI: https://doi.org/10.52403/ijhsr.20260135
Diagnostic Utility of Head CT Rule in Predicting Intracranial Injuries in Minor Traumatic Brain Injury: A Prospective Analysis from a Tertiary Emergency Care Centre in India
Dr. Chinju Raja Punnen1, Dr. Abhinov Thamminaina2, Dr. Abhilash3, Dr. Amal Raja Punnen4
1Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad,
2Dept. of Emergency Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad
3Department of Critical Care, Aarupadai Veedu Medical College, Puducherry
4MBBS, Tbilisi State Medical University, Tbilisi, Georgia
Corresponding Author: Dr. Abhinov Thamminaina
ABSTRACT
Background: Minor head injuries with Glasgow Coma Scale (GCS) score of 13-15 account for approximately 84% of all traumatic brain injuries. While the vast majority of these patients have favourable outcomes, identifying those requiring neurosurgical intervention from those who can be safely managed conservatively remains clinically challenging. The Canadian CT Head Rule (CCHR) is a well-established and validated clinical decision instrument for selective computed tomography imaging in minor head injury, yet its diagnostic utility in Indian populations requires systematic evaluation.
Objectives: The primary objectives of this study were to estimate the diagnostic accuracy of CCHR in predicting intracranial injuries on CT scan and to assess the association between Glasgow Coma Scale score and structural abnormalities in minor head injury patients.
Methods: A prospective, cross-sectional, hospital-based study was conducted over an 18-month period at the Emergency Department. Adults aged 16 years and above presenting with minor head injury (GCS 13-15, injury sustained within 24 hours) were enrolled consecutively. All patients underwent systematic CCHR assessment following stabilisation according to Advanced Trauma Life Support protocols, followed by non-contrast head CT imaging. Statistical analysis included calculation of sensitivity, specificity, predictive values, likelihood ratios, and chi-square tests with p<0.05 as the threshold for statistical significance.
Results: Among 203 study participants with mean age 49.5±20.6 years and male predominance of 70%, positive CT findings were documented in 116 patients (57.1%). Neurosurgical intervention was required in 10 patients (8.6% of those with positive CT). CCHR demonstrated sensitivity of 68.1% (95% CI 61.2%-75.0%) and specificity of 42.5% for predicting positive CT findings. Retrograde amnesia (p<0.01), ear/nose/throat bleed (p<0.01), and hemotympanum (p=0.008) showed statistically significant correlation with positive CT. Notably, neurological features, including post-traumatic seizures and pupillary abnormalities, demonstrated 100% sensitivity for identifying positive CT findings.
Conclusion: In this Indian cohort, CCHR demonstrated moderate sensitivity and specificity for CT prediction, findings comparable to international validation studies. The Canadian CT Head Rule provides a practical, clinically useful tool for systematic risk stratification of minor head injury patients in emergency settings, facilitating judicious use of imaging resources while maintaining diagnostic accuracy. Implementation in Indian emergency departments can optimise resource allocation, reduce patient costs, minimise unnecessary radiation exposure, and provide evidence-based standardisation of minor head injury evaluation, particularly in resource-constrained healthcare systems.
Key words: Minor head injury, Canadian CT Head Rule, Traumatic brain injury, Clinical decision rule