First10 EM - By Justin Morgenstern - February 6, 2023
The paper
Stiell IG, Clement CM, Grimshaw JM, Brison RJ, Rowe BH, Lee JS, Shah A, Brehaut J, Holroyd BR, Schull MJ, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, Macphail I, Ross S, Perry JJ, Ip U, Lesiuk H, Bennett C, Wells GA. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. CMAJ. 2010 Oct 5;182(14):1527-32. doi: 10.1503/cmaj.091974. Epub 2010 Aug 23. PMID: 20732978
Bottom line
This has been true for over a decade, but nobody should be using the Canadian CT head rule. It is one of the few decision rules that we have implementation research for, and this cluster RCT demonstrates no benefit, and I believe suggests harm, despite being the best possible scenario for the Canadian CT head rule.