CHIP (CT in Head Injury Patients) Prediction Rule

CHIP Rule
Major Criteria:
GCS <15
Post-Traumatic Seizure
Focal Neurological Deficit
Clinical Signs of Skull Fracture
Vomiting ≥2 Episodes
Known Coagulopathy
Age ≥60 with Fall from Any Height
Minor Criteria:
Loss of Consciousness
Post-Traumatic Amnesia ≥4 hours
Pedestrian or Cyclist vs. Vehicle
Ejected from Vehicle
Vomiting (1 episode)
Age ≥40
Use of Anticoagulants
Persistent Headache
GCS 15 with LOC
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Predicts intracranial traumatic CT findings in patients with minor head trauma.

Why Use

Provides structured, validated criteria to identify patients at risk for significant intracranial pathology. Helps balance the risks of potentially unnecessary ionizing radiation against the need for timely diagnosis. Unlike similar tools, these criteria were developed for patients with minor head injury, with or without loss of consciousness.

When to Use

Use to evaluate whether a head CT scan is warranted to detect intracranial injuries after minor head trauma.

Formula

If ≥1 major criterion OR ≥2 minor criteria are present, CT head is required. Major criteria: Pedestrian or cyclist versus vehicle. Ejected from vehicle. Vomiting. Post-traumatic amnesia ≥4 hours. Clinical signs of skull fracture*. GCS <15. GCS deterioration ≥2 points (1 hour after presentation). Use of anticoagulant therapy. Post-traumatic seizure. Age ≥60 years. Minor criteria: Fall from any elevation. Persistent anterograde amnesia**. Post-traumatic amnesia of 2 to <4 hours. Contusion of the skull. Neurologic deficit. Loss of consciousness. GCS deterioration of 1 point (1 hour after presentation) Age 40–60 years. *Any injury that suggests a skull fracture, such as palpable discontinuity of the skull, leakage of cerebrospinal fluid, “raccoon eye” bruising, and bleeding from the ear. **Persistent anterograde amnesia is any deficit of short-term memory.

Pearls / Pitfalls

This tool is based on the original derivation study. A 2022 update boasts improved sensitivity for detecting potential neurosurgical lesions without increasing CT rates. Not intended for pediatric populations under age 16; consider using a pediatric-specific tool, like PECARN . Relies on the clinician’s ability to detect subtle clinical signs, such as skull fractures or scalp hematomas.

Management

Low risk: Consider observation without immediate imaging if the patient remains clinically stable. Educate the patient and caregivers on warning signs that require re-evaluation. Not low risk: Proceed with urgent head CT imaging to rule out life-threatening intracranial pathology.

Critical Actions

If clinical suspicion for intracranial pathology is high, CT imaging is indicated regardless of the tool’s results.

Advice

This prediction rule should support, not replace, clinical judgment.

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