EAD INJURY IS ONE OF THE most common injuries in the Western world with an estimated incidence of hospitaltreated patients with minor head injury of 100 to 300 per 100 000 population. 1 Minor head injury is commonly defined as blunt trauma to the head, after which the patient has lost consciousness for less than 15 minutes or has a short posttraumatic amnesia of less than 1 hour, or both, as well as a normal or minimally altered mental status on presentation (a Glasgow Coma Scale [GCS] score of 13-15). 2,3 Intracranial complications of minor head injury are infrequent (6%-21%) but potentially life-threatening and may require neurosurgical intervention in a minority of cases (0.4%-1.0%). 3-8 Neurocranial injury that does not require See also pp 1511 and 1551 and Patient Page.

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The authors propose the highly sensitive CHIP prediction rule for the selective use of CT in patients with minor head injury with or without loss of consciousness.

With the increasing possibilities for surgical treatment of colorectal liver metastases, careful selection of patients who may benefit from surgical treatment becomes critical. The addition of PET to 18 F-FDG may significantly improve conventional staging by CT. Up to now, definitive evidence that the addition of 18 F-FDG PET to conventional staging leads to superior clinical results and improved clinical management in these patients has been lacking. In this randomized controlled trial in patients with colorectal liver metastases, we investigated whether the addition of 18 F-FDG PET is beneficial and reduces the number of futile laparotomies. Methods: A total of 150 patients with colorectal liver metastases selected for surgical treatment by imaging with CT were randomly assigned to CT only (n 5 75) or CT plus 18 F-FDG PET (n 5 75). Patients were followed up for at least 3 y. The primary outcome measure was futile laparotomy, defined as any laparotomy that did not result in complete tumor treatment, that revealed benign disease, or that did not result in a disease-free survival period longer than 6 mo. Results: Patient and tumor characteristics were similar for both groups. The number of futile laparotomies was 34 (45%) in the control arm without 18 F-FDG PET and 21 (28%) in the experimental arm with 18 F-FDG PET; the relative risk reduction was 38% (95% confidence interval, 4%260%, P 5 0.042). Conclusion: The number of futile laparotomies was reduced from 45% to 28%; thus, the addition of 18 F-FDG PET to the work-up for surgical resection of colorectal liver metastases prevents unnecessary surgery in 1 of 6 patients.