Cited by 127Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesTrauma and Emergency Care Studies

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ACR Appropriateness Criteria Head Trauma

Shetty, Vilaas S., Reis, Martin N., Aulino, Joseph M., Berger, Kevin L., Broder, Joshua, Choudhri, Asim F., Kendi, A. Tuba, Kessler, Marcus M., Kirsch, Claudia F., Luttrull, Michael D., Mechtler, Laszlo L., Prall, J. Adair, Raksin, Patricia B., Roth, Christopher J., Sharma, Aseem, West, O. Clark, Wintermark, Max, Cornelius, Rebecca S., Bykowski, Julie·2016·Journal of the American College of Radiology

DOI 10.1016/j.jacr.2016.02.023

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Abstract

Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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Authors: Shetty, V. S., Reis, M. N., Aulino, J. M., Berger, K. L., Broder, J., Choudhri, A. F., Kendi, A. T., Kessler, M. M., Kirsch, C. F., Luttrull, M. D., Mechtler, L. L., Prall, J. A., Raksin, P. B., Roth, C. J., Sharma, A., West, O. C., Wintermark, M., Cornelius, R. S., & Bykowski, J.
Affiliations: Saint Louis University Hospital (US)
Saint Louis University (US)
Vanderbilt University (US)
Duke University (US)
University of Tennessee Health Science Center (US)
Emory University Hospital (US)
University of Arkansas for Medical Sciences (US)
The Ohio State University Wexner Medical Center (US)
American Academy of Neurology (US)
Littleton Adventist Hospital (US)
Rush University (US)
Duke Medical Center (US)
Stanford Medicine (US)
University of Cincinnati Medical Center (US)
University of California San Diego (US)
Corresponding author: Shetty, Vilaas S.
ORCID: Broder, Joshua
Choudhri, Asim F.
Kendi, A. Tuba
Kessler, Marcus M.
Kirsch, Claudia F.
Mechtler, Laszlo L.
Raksin, Patricia B.
Roth, Christopher J.
Sharma, Aseem
Wintermark, Max
Bykowski, Julie
Venue: Journal of the American College of Radiology
Publisher: Elsevier BV
Published: 2016-06
Volume: 13
Issue: 6
Pages: 668-679
ISSN: 1546-1440 (ISSN-L)
DOI: 10.1016/j.jacr.2016.02.023
OpenAlex: W2413232129
Cited by: 127
References: 66
Citations by year: 2026: 3 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 14 · 2021: 23 · 2020: 17 · 2019: 13 · 2018: 15 · 2017: 7 · 2016: 3
FWCI: 7.74
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American College of Radiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords: head trauma, traumatic brain injury, non-contrast head CT, CT angiography, magnetic resonance angiography, venography, cisternography, mild traumatic brain injury, chronic traumatic brain injury
MeSH terms: Craniocerebral Trauma, Humans, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Glasgow Coma Scale, Evidence-Based Medicine, Neuroimaging

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