CHIP (CT in Head Injury Patients) Prediction Rule
The CHIP rule (Smits 2007) selects adults (≥ 16 years) with minor head injury (GCS 13–15) for CT, with or without loss of consciousness. Derivation: sensitivity 100% for neurosurgical intervention and 94–96% for intracranial traumatic CT findings.
Score interpretation
No major criterion and fewer than 2 minor criteria.
→ CHIP does not indicate CT. Discharge with written head injury advice; return if worsening headache, repeated vomiting, seizure, drowsiness, weakness, CSF leak or confusion. In the UK, also apply NICE NG232 criteria.
At least 1 major or 2 minor CHIP criteria are present.
→ Perform CT head; neurological observations while awaiting it. Refer to neurosurgery if CT shows intracranial haemorrhage, a depressed skull fracture or another significant lesion.
Interpretation bands for the CHIP Rule. Apply clinical judgement and local guidance.
References
- Smits M, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med. 2007;146(6):397-405.
- Foks KA, et al. External validation of computed tomography decision rules for minor head injury: prospective, multicentre cohort study in the Netherlands. BMJ. 2018;362:k3527.
- NICE NG232. Head injury: assessment and early management. NICE. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Cetuximab · Anti-EGFR Monoclonal Antibody — Head and Neck Cancer
- Cisplatin · Platinum Chemotherapy — Head and Neck Cancer
- Methotrexate · Chemotherapy / Immunosuppressant — Head and Neck / Granulomatosis
- Pembrolizumab (Head and Neck SCC) · PD-1 Inhibitor
- Nivolumab (Head and Neck SCC) · PD-1 Inhibitor
- 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
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.