Doctor, I have head trauma, headache and nausea and would like to have a CT scan. This is the most common request made by neurosurgery patients to doctors. Patients often cite a friend or relative they know who did not have a CT scan for a minor head trauma that resulted in a brain hemorrhage and delayed access to care. In addition, emergency physicians often encounter patients with head trauma who are conscious and whose families do not agree with the physician’s treatment of the patient for observation and request a CT. If today there is no health insurance coverage and the patient pays for everything, I think any physician would be happy to accept the patient’s or family’s request, but nowadays physicians often have to make a choice between wasting medical resources and taking care of the patient’s rights. This is what we will discuss when to do CT for head trauma. For head trauma patients, physicians will assess the patient’s coma scale. A normal person has a score of 15 and a completely unresponsive person has a score of 3. A Coma Scale score of 15 to 13 is considered mild head trauma, a score of 12 to 9 is considered moderate head trauma, and a score of 8 or less is considered severe head trauma. The likelihood of intracranial hemorrhage in mild head trauma is very small and is usually observed for 24 hours without the need for CT, while the likelihood of intracranial hemorrhage in moderate and severe head trauma is much higher and requires CT examination. Why some patients with head trauma are awake when they are first brought to the emergency room (coma index of 15), but a few hours later, they are in a coma with life-threatening intracranial hemorrhage, which is the biggest question for outpatients or emergency room patients and their families mentioned earlier. Here we must explain a little about the structure of our head. The skull can be divided from the outside into the scalp, skull, dura mater, arachnoid and brain parenchyma. Between the skull and the dura, there are arteries that sometimes rupture and bleed as a result of head trauma. As time passes, a hematoma, called an epidural hematoma, forms between the skull and the dura mater. However, the patient’s brain parenchyma is not injured and is therefore awake. If the epidural hematoma continues to grow and compress the brain parenchyma causing an increase in brain pressure, the patient may become agitated, comatose, or even life-threatening. Such a rapid change in clinical symptoms is rarely seen in patients with mild head trauma. This is why the doctor will first observe the patient’s consciousness and neurological response rather than directly performing a CT examination. However, if the patient and family are not satisfied with the doctor’s explanation that “life is at stake”, they would rather see a normal CT than a CT with intracranial hemorrhage, and because there are health insurance regulations for CT. I think that paying for the test is the only viable option. (At present, the doctor-patient relationship is tense, the conflict is large, the doctor-patient lack of trust, can be relaxed to do CT indications, currently Jiaxing area medical insurance patients can do CT without audit, self-pay patients can also afford the corresponding CT examination costs) In addition, CT examination for cranial trauma patients, better than cranial plain film, MRI examination, examination time is short, intracranial, skull and other conditions can be examined.