In patients with GCS scores of 13 to 15, the Canadian CT Head Rule also was 100 percent sensitive, identifying all 41 patients requiring neurosurgical intervention and all 231 patients with clinically important brain injury.

However, the Canadian CT Head Rule was more specific than the New Orleans Criteria and led to a greater reduction in head CT scans (52 versus 88 percent). In the normal GCS subgroup, both rules were 100 percent sensitive, identifying all eight patients requiring neurosurgical intervention and all 97 patients with clinically important brain injury. Because the New Orleans Criteria was designed for patients with normal GCS scores, a subgroup that included only patients with a normal GCS score of 15 (n = 1,822) was used to compare the two rules.

The first study, 3 conducted by the original Canadian CT Head Rule developers, identified 2,707 patients 16 to 99 years of age with minor head injury (defined as blunt head trauma within the previous 24 hours causing loss of consciousness, definite amnesia, or witnessed disorientation) and GCS scores of 13 to 15. It is a natural reaction to the wear and tear of the body and mind after extended and demanding operations. It is most commonly associated with head injuries, especially those resulting. Two studies 3, 5 have directly compared the New Orleans Criteria with the Canadian CT Head Rule. Combat stress, also known as battle fatigue, is a common response to the mental and emotional strain that can result from dangerous and traumatic experiences. Battle Sign is a medical condition characterized by bruising behind the ear.

The sign is named after William Henry Battle. Battles sign consists of bruising over the mastoid process as a result of extravasation of blood along the path of the posterior auricular artery. These fractures may be associated with underlying brain trauma. Clinical decision rules should be validated prospectively in a new population to confirm their accuracy, particularly when the consequences of error are great, as they are with head injury. Battles sign, also known as mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull.

Battle signs trauma