Variant 1: Acute head trauma, mild (GCS 13–15), imaging not indicated by clinical decision rule. Initial imaging.
Variant 2: Acute head trauma, mild (GCS 13-15), imaging indicated by clinical decision rule. Initial imaging.
Variant 3: Acute head trauma, moderate (GCS 9–12) or severe (GCS 3–8), or penetrating. Initial imaging.
Variant 4: Acute head trauma with unchanged neurologic examination and unremarkable initial imaging. Short-term follow-up imaging.
Variant 5: Acute head trauma with unchanged neurologic examination and positive finding(s) on initial imaging (eg, subdural hematoma). Short-term follow-up imaging.
Variant 6: Acute head trauma with new or progressive neurologic deficit(s). Short-term follow-up imaging.
Variant 7: Subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). Initial imaging.
Variant 8: Head trauma with suspected intracranial arterial injury due to clinical risk factors or positive findings on prior imaging.
Variant 9: Head trauma with suspected intracranial venous injury due to clinical risk factors or positive findings on prior imaging.
Variant 10: Head trauma with suspected cerebrospinal fluid (CSF) leak. Initial imaging.
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.