Healthcare & Clinical
New Orleans Criteria (NOC) Head CT Rule for GCS 15 Minor Head Trauma
Apply Michelle Haydel’s 7-item New Orleans Criteria (Headache, Vomiting, Age > 60, Drug/Alcohol Intoxication, Persistent Anterograde Amnesia, Visible Trauma Above Clavicles, Seizure) in GCS = 15 blunt head injury with LOC.
Know the critical scope difference between New Orleans Criteria (GCS = 15 ONLY) and CCHR (GCS 13–15)!
Michelle Haydel et al. (2000, New England Journal of Medicine) derived and validated the 7-item New Orleans Criteria (NOC) with 100% sensitivity for acute traumatic intracranial lesions in minor blunt head trauma—strictly restricted to neurologically intact patients with initial Glasgow Coma Scale GCS = 15 after witnessed loss of consciousness (Age > 3 yr; patients with GCS 13 or 14 automatically fall outside NOC clearance and require CT or CCHR)!
Among GCS = 15 patients with normal brief neurological exam, non-contrast Head CT is required if ANY 1 of 7 findings is present: (1) Headache (diffuse or localized), (2) Vomiting, (3) Age > 60 years, (4) Drug or alcohol intoxication, (5) Persistent anterograde amnesia (short-term memory deficits), (6) Visible trauma above the clavicles (scalp/facial contusion or laceration), or (7) Post-traumatic seizure. Only when ALL 7 criteria are absent (0 / 7) does NOC clear the patient without head CT!
| New Orleans Criteria Group (GCS = 15 + LOC Required) | Clinical Triggers (+1 Each) | Head CT Action |
|---|---|---|
| Eligibility Gate | GCS < 15 or Focal Neurologic Deficit | "Not Eligible for NOC Clearance (Order Head CT)" |
| Symptoms & History (4 items) | Headache, Vomiting, Drug/Alcohol Intox, Seizure | >= 1 Positive -> Order Non-Contrast Head CT |
| Age, Memory & Exam (3 items) | Age > 60, Persistent Short-Term Amnesia, Trauma > Clavicles | 0 / 7 Positive -> Safe to Defer Head CT |
Count of Positive New Orleans Criteria (0 to 7)
Sums Age > 60 (B3 > 60) with the six binary bedside findings (B4:B9).
=IF(B3 > 60, 1, 0) + IF(B4 = 1, 1, 0) + IF(B5 = 1, 1, 0) + IF(B6 = 1, 1, 0) + IF(B7 = 1, 1, 0) + IF(B8 = 1, 1, 0) + IF(B9 = 1, 1, 0)New Orleans Criteria Head CT Decision With GCS = 15 Gate
Enforces GCS = 15 (B2 = 15) and Age > 3 before clearing 0-criterion patients.
=IF(OR(B2 < 3, B2 > 15, B3 <= 3), "Invalid / Pediatric <3y Exclusion", IF(B2 < 15, "GCS < 15: Outside NOC Scope — Head CT Indicated", IF((IF(B3 > 60, 1, 0) + SUM(B4:B9)) >= 1, "Head CT Indicated (>= 1 New Orleans Criterion)", "No Head CT Required (All 7 NOC Negative)")))Try the example
Use the original values or change them to test your understanding.