Inclusion:
Non-penetrating trauma to the head
Presentation to ED within 24 hours of injury
GCS 14 or 15 on initial evaluation in ED
Age ≥ 16
Exclusion:
Penetrating trauma
Patients with multi-system trauma
GCS < 14 on initial evaluation in the ED
Age  < 16
Level A:
A noncontrast head CT indicate in head trauma patients with LOC or post-traumatic amnesia only if ≥ 1 of following is present:
Headache
Vomiting
Age> 60
Drug or alcohol intoxication
Deficits in short-term memory
Physical evidence of trauma above the clavicle
Post-traumatic seizure
GCS < 15
Focal neurological deficit
Coagulopathy
Level B:
A noncontrast head CT should be considered in head trauma patients with no LOC or post-traumatic amnesia if there is:
Focal neurological deficit
Vomiting
Severe headache
Age ≥ 65
Physical signs of basilar skull fracture
GCS < 15
Coagulopathy
Dangerous mechanism of injury
Patients with an isolated TBI who have a negative head CT scan result are at a minimal risk for developing an intracranial lesion and therefore may be safely discharged from the ED.
Level C:
In mild TBI patient with significant extracranial injuries and a serum S-100B level ≤ 0.5ℳg/L measured w/in 4 hours if injury, consideration can be given to not performing a CT.
Mild TBI patients discharged from the E should be informed abut post-concussive symptoms.
No specific recommendation for use of head MRI in patient with mild TBI
Non-penetrating trauma to the head
Presentation to ED within 24 hours of injury
GCS 14 or 15 on initial evaluation in ED
Age ≥ 16
Penetrating trauma
Patients with multi-system trauma
GCS < 14 on initial evaluation in the ED
Age  < 16
A noncontrast head CT indicate in head trauma patients with LOC or post-traumatic amnesia only if ≥ 1 of following is present:
Headache
Vomiting
Age> 60
Drug or alcohol intoxication
Deficits in short-term memory
Physical evidence of trauma above the clavicle
Post-traumatic seizure
GCS < 15
Focal neurological deficit
Coagulopathy
Headache
Vomiting
Age> 60
Drug or alcohol intoxication
Deficits in short-term memory
Physical evidence of trauma above the clavicle
Post-traumatic seizure
GCS < 15
Focal neurological deficit
Coagulopathy
A noncontrast head CT should be considered in head trauma patients with no LOC or post-traumatic amnesia if there is:
Focal neurological deficit
Vomiting
Severe headache
Age ≥ 65
Physical signs of basilar skull fracture
GCS < 15
Coagulopathy
Dangerous mechanism of injury
Patients with an isolated TBI who have a negative head CT scan result are at a minimal risk for developing an intracranial lesion and therefore may be safely discharged from the ED.
Focal neurological deficit
Vomiting
Severe headache
Age ≥ 65
Physical signs of basilar skull fracture
GCS < 15
Coagulopathy
Dangerous mechanism of injury
In mild TBI patient with significant extracranial injuries and a serum S-100B level ≤ 0.5ℳg/L measured w/in 4 hours if injury, consideration can be given to not performing a CT.
Mild TBI patients discharged from the E should be informed abut post-concussive symptoms.
ACEP clinical policies
Sign out tools
Reexamination sample documentation
Mass casualty incident triage
STOPP/START criteria
Denver screening criteria
Critical care documentation
Clinical decision rules list