Clinical condition—head trauma

	CT, head, without contrast	MRI, brain, without contrast	X-ray and/or CT, cervical spine †	CT, head, without and with contrast	MRI, brain, without and with contrast	CTA, head and neck	MRA, head and neck	Angiography, cerebral	X-ray, skull
Minor or mild acute closed head injury (GCS ≥13), without risk factors or neurologic deficit	7a	4	5	3	2	3b	3b	1	1
Minor or mild acute closed head injury, focal neurologic deficit and/or risk factors	9	6c	6	2	3	5cd	5cd	1	1
Moderate or severe acute closed head injury	9	6	8	2	2	5	5	1	2
Mild or moderate acute closed head injury, child <2 years old	9	7e	7	2	4f	4d	4d	1	5
Subacute or chronic closed head injury with cognitive and/or neurologic deficit(s)g	6	8	2h	2	3	4i	4i	1	2
Closed head injury; rule out carotid or vertebral artery dissection‡	8	8e	5	6j	6	8	8k	6c	2
Penetrating injury, stable, neurologically intact	9	5l	8m	4j	4l	7	6l	5d	8n
Skull fracture	9	6l	6	4	4lo	7d	4l	1	5i

Note:—Appropriateness criteria scale from 1 to 9; 1 indicates least appropriate; 9, most appropriate;

^a, known to be low yield;

^b, rarely indicated with mild trauma;

^c, for problem solving;

^d, if vascular injury suspected;

^e, include diffusion-weighted images;

^f, potentially useful in suspected non-accidental trauma;

^g, PET or SPECT for brain = 4–used for selected cases;

^h, assuming there are no spinal neurologic deficits;

ⁱ, for selected cases;

^jconsider perfusion;

^k, add T1 images;

^l, if MRI is safe;

^m, if neck or C-spine is site of injury;

ⁿ, if calvarium is site of injury;

^o, useful if infection is suspected.

^†, see the ACR Appropriateness Criteria on Spine Trauma;

^‡, see the ACR Appropriateness Criteria on Cerebrovascular Disease.