Patterns of Head CT Utilization in Emergency Department Patients With Minor Head Injury: A Systematic Review

Minor head injury (MHI) is a frequent presentation to emergency departments (EDs), and while most patients recover uneventfully, a small proportion develop clinically important traumatic brain injury (ciTBI). Computed tomography (CT) is the diagnostic gold standard for detecting intracranial pathology, but its widespread use contributes to unnecessary radiation exposure, higher costs, and ED crowding. To optimize utilization, several clinical decision rules, including the Canadian CT Head Rule, New Orleans Criteria, National Emergency X-Radiography Utilization Study II (NEXUS-II), and National Institute for Health and Care Excellence (NICE) guidelines, have been developed to balance sensitivity for ciTBI with the need to limit avoidable scans. This systematic review, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, searched PubMed, Embase, Scopus, and the Cochrane Library up to August 2025. Of the 96 records screened, five studies with over 44,000 patients met the inclusion criteria. The findings indicate that although decision rules demonstrate high sensitivity and strong potential to reduce unnecessary imaging, variability in adherence leads to both overuse and underuse of CT. Greater integration of validated rules into clinical workflows and decision-support systems is needed to enhance patient safety, reduce costs, and improve efficiency in the management of MHI.