Patient requires inpatient observation if GCS <15, seizure activity present, anticoagulation or bleeding diathesis, or no responsible caregiver to discharge to
Patient may be discharged for outpatient observation if (all of the following):
No head CT required per above criteria OR head CT performed and not requiring neurosurgical intervention
Patient GCS 15 on discharge
No seizures
No anticoagulation or bleeding diathesis
Responsible caregiver at home to discharge to
Given good follow up instructions detailing a graded return-to-activity program and symptoms to anticipate during recovery 
Discharge patient to care of responsible individual
Patients might not understand discharge instructions so repeat them to the individual taking care of the patient
In one study of adolescents, strict rest immediately after<unk>  TBI offered no benefit. 
Physical activity at any level (light aerobic, moderate, full) within first 7 days compared with no activity associated with lower rates of persistent symptoms at 28 days (29% vs. 40%)
Multicohort study - 2400 children, aged 5-18, in the emergency department
Still recommend strict rest for first 24-48 hours
Follow up for full examination, gait and cognition testing
Mini-Mental State Exam
Standardized Assessment for Concussion
Takes 10-15 mins to administer, often not performed in ED
Multicohort study - 2400 children, aged 5-18, in the emergency department
Still recommend strict rest for first 24-48 hours
Mini-Mental State Exam
Standardized Assessment for Concussion
Takes 10-15 mins to administer, often not performed in ED
Takes 10-15 mins to administer, often not performed in ED
Mild traumatic brain injury
Traumatic brain injury
Moderate-to-severe traumatic brain injury
Intracranial hemorrhage
Post-concussive syndrome
Traumatic intracerebral hemorrhage
Elevated intracranial pressure
Ischemic stroke