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Canadian CT Head Rule

Contributed by Dr. David Page

HTML icon CanadianCTHeadRule.html — HTML, 9 kB (9772 bytes)

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<html>
<head>
<title>Canadian CT Head Rule</title>
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<body onload="passAge();">
<form method="post" action="" name="FormName">

<p class="title">
	Canadian CT Head Rule for patient with minor head injury
</p>


<div name="demographics">
<table width="50%">
	<tr>
		<td class="heading1" width=25%>Patient name</td>
		<td class="formtext"><input class="formtext" name="PatientName" type="text" oscarDB=patient_name>
	</tr>
	<tr>
		<td class="heading1">Date:</td>
		<td class="formtext"><input class="formtext" name="TodaysDate" type="text" oscarDB=today>
	</tr>
        <tr>
		<td class="heading1">Patients age:</td>
		<td class="formtext"><input class="formtext" name="Age" id="Age" type="text" oscarDB=age>
	</tr>
</table>
</div>

<br>

<div name="Questionnaire">
<table width="50%">
         <tr>
		<td class="QuestionHeading" width=100%>Guideline for ordering CT of the head after blunt head trauma AND A HISTORY of loss of conciousness OR amnesia OR disorientation.</u></td>
         </tr>
         <tr>   
                <td class="QuestionHeading" width=60%></u></td>
                <td class="AnswerHeading" width=20%>Yes</td>
                <td class="AnswerHeading" width=20%>No</td>
		 
		
	</tr>

	
       
        <tr class="even">
		<td class="question"><p class="normal">GCS < 15 at 2hrs after injury </p></td>
		
                <td class="answer"><input type="radio" name="Q1" value="10"></td>
                <td class="answer"><input type="radio" name="Q1" value="0"></td>
		
	<tr>
   

	<tr class="even">
		<td class="question"><p class="normal">Suspected open or depressed skull fracture</p></td>
		
                <td class="answer"><input type="radio" name="Q2" value="10"></td>
		<td class="answer"><input type="radio" name="Q2" value="0"></td>
	</tr>

      

	<tr class="even">
		<td class="question"><p class="normal">Any sign of basal skull fracture</p></td>
		
		<td class="answer"><input type="radio" name="Q3" value="10"></td>
		<td class="answer"><input type="radio" name="Q3" value="0"></td>
	</tr>
        

	<tr class="even">
		<td class="question"><p class="normal">Two or more episodes of vomiting</p></td>
		<td class="answer"><input type="radio" name="Q4" value="10"></td>
		<td class="answer"><input type="radio" name="Q4" value="0"></td>
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Age 65yrs or more</p></td>
		<td class="answer"><input type="radio" name="Q5" id="65" value="10"></td>
		<td class="answer"><input type="radio" name="Q5" id="55" value="0"></td>
	<tr>
        
          <tr class="even">
		<td class="question"><p class="normal">Retrograde amnesia > 30 minutes</p></td>
		<td class="answer"><input type="radio" name="Q6" value="1"></td>
		<td class="answer"><input type="radio" name="Q6" value="0"></td>
	<tr>
        
         
        <tr class="even">
		<td class="question"><p class="normal">Dangerous mechanism(fall >3', ped struck,ejected from MVA</p></td>
		<td class="answer"><input type="radio" name="Q7" value="1"></td>
		<td class="answer"><input type="radio" name="Q7" value="0"></td>
	<tr>
	
	
</table>
<br>
<table>
<tr>
	<td><input type="button" onclick="totalScore()" value="Score:"></td>
	<td><input type="text" name="Score" size="10"value=""></td>
</tr>
</table>

</div>


<br>
<br>



<div name="Application" class="DoNotPrint">
<table width=50%>

<tr>
	<td class="heading1" colspan="2">Recommendations</td>
</tr>
<tr id="high">
	
	<td>High Risk: CT Head Required </td>
</tr>
<tr id="moderate">
	
	<td>Moderate Risk: CT Head Recommended </td>
</tr>
<tr id="low">
	
	<td>Low Risk: CT Head Not Recommended </td>
</tr>

</table>

<br>
<br>
</div>


<br>
<br>

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</body>
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