Letters to the editor [Stein et al.]

Stein et al. report on the cost effectiveness of using computed tomography (CT) for minor head injury compared with several other management strategies. They conclude that the selective use of CT in patients with minor head injury according to the Canadian CT Head Rule (CCHR) is the most cost-effective management strategy. However, we think that their analysis is based on several debatable assumptions that may undermine the validity, and consequently the conclusion of their article.
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This still leaves the key questions unanswered: hoe many patients can we afford to miss using a selective CT strategy? Can we afford to miss any at all or are the additional costs of scanning all patients with minor head injury justified compared with the gains in survival and quality-of-life?