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Template:ACEP TBI policy
From WikEM
- 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
- A noncontrast head CT indicate in head trauma patients with LOC or post-traumatic amnesia only if ≥ 1 of following is present:
- 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.
- A noncontrast head CT should be considered in head trauma patients with no LOC or post-traumatic amnesia if there is:
- 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
