CT Head Rules (NICE/Canadian)
Combines NICE CG176 and Canadian CT Head Rule criteria for immediate CT head in adults with head injury. Reduces unnecessary CT while identifying neurosurgically significant injuries.
Score interpretation
→ Observation 4 hours; safe discharge with head injury advice leaflet if GCS 15 and no ongoing symptoms; return if: worsening headache, vomiting, confusion, seizure, limb weakness; GP follow-up if persistent symptoms
→ CT head within 1 hour of risk factor identification; neurosurgery referral criteria: GCS <13, contusion, midline shift; monitor in ED; reassess neurological status every 30 min
→ CT head immediately (<1 hour); neurosurgical referral; anticoagulation reversal (idarucizumab for dabigatran, andexanet alfa for Xa inhibitors, vitamin K + PCC for warfarin); HDU monitoring; neurosurgical consult if: haematoma >1cm, midline shift >5mm, posterior fossa lesion
Interpretation bands for the CT Head Rules. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Terlipressin · Gastrointestinal Emergency
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Featured in these MRCEM clinical pathways
The CT Head Rules is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.