Neuroimaging and decision making in TBI (2008)

  • 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

Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714-748.

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