CT in Head Injury Patients Prediction Rule

CHIP Prediction Rule Calculator

Neurology · Emergency Medicine

CHIP (CT in Head Injury Patients) Prediction Rule

Predicts intracranial traumatic CT findings in patients with minor blunt head trauma.

Use only within the rule’s intended population

Adults aged 16 years or older presenting within 24 hours of blunt head trauma, with an initial GCS of 13–15. Do not use this calculator as a substitute for clinical judgment or local head-injury guidance.

Clinical criteria

Complete every field. The original simple CHIP rule classifies criteria as major or minor rather than producing a single numeric score.

Age

The rule is intended for patients aged 16 years or older.

years
Age 40–59 is a minor criterion; age ≥60 is a major criterion.
GCS <15

Initial GCS at presentation. The CHIP population is limited to GCS 13–15.

GCS deterioration at 1 hour after presentation
Skull injury

Skull contusion means a clinically significant skin discontinuity or extensive bruising. Signs suggesting fracture include palpable skull discontinuity, CSF leakage, raccoon eyes, or bleeding from the ear.

Post-traumatic amnesia

Duration for which the patient cannot recall the traumatic event or subsequent period.

Pedestrian or cyclist versus vehicle
Ejected from vehicle
Vomiting

At least one episode of emesis after the traumatic event.

Use of anticoagulants
Post-traumatic seizure

Seizure witnessed or suspected after injury.

Fall from any elevation
Persistent anterograde amnesia

Any persistent short-term memory deficit.

Neurologic deficit

Any abnormality on routine neurologic examination indicating a focal cerebral lesion.

Loss of consciousness

Included because loss of consciousness is a minor criterion in the original simple CHIP rule.

How the rule is interpreted
ClassificationCHIP recommendation
At least 1 major criterionHead CT indicated
No major criteria and at least 2 minor criteriaHead CT indicated
No major criteria and 0–1 minor criterionLow risk by the simple CHIP rule; CT is not indicated by this rule alone
Important limitations
  • This page implements the original simple CHIP prediction rule, not the later updated CHIP model.
  • It is not validated for patients younger than 16 years, penetrating head trauma, or initial GCS outside 13–15.
  • Clinical decision rules support—but do not replace—assessment, observation, local guidance, or senior review.
Reference

Smits M, Dippel DWJ, Steyerberg EW, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Annals of Internal Medicine. 2007;146(6):397–405. doi:10.7326/0003-4819-146-6-200703200-00004.

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