Head CT Guideline for Adult Trauma Patients with Potential Minor Traumatic Brain Injury

Objectives

Describes inclusion and exclusion criteria for application of a rule defining patients on whom to perform a head CT on in the setting of a potential minor TBI.

Scope

Inclusion criteria

Patient has evidence of minor head injury
- Blunt trauma to the head resulting in witnessed LOC, definite amnesia, or witnessed disorientation
  or
- Initial GCS 13-15 and injury within the past 24 hours

Exclusion criteria

Patient has evidence of potential major head injury - Requires immediate head CT or head CT after stabilization
- Obvious penetrating skull injury or depressed skull fracture
- \Acute focal neurological deficit
- Unstable vital signs associated with major trauma
- Seizure prior to ED assessment
Patient has bleeding disorder or is on anticoagulation and/or antiplatelet therapy - Requires immediate head CT for any history of head injury
Unclear history of trauma as the primary event (Ex: primary seizure or syncope)
Return for reassessment of the same head injury
Pregnant
Age<18

Rule - Head CT required if any the following are present

Age ≥ 65 years
Vomiting > 2 times
Signs suggesting basal skull fracture
- Hemotympanum
- Raccoon eyes
- CSF otorrhea or rhinorrhea
- Battle’s sign (bruising around mastoid process)
GCS < 15 at 2 hours post injury
Retrograde amnesia > 30 min
Dangerous mechanism
- Pedestrian struck by vehicle
- Ejection from motor vehicle
- Fall from elevation >3 feet or 5 stairs

Special Thanks

Attribution

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Title: Head CT Guideline for Adult Trauma Patients with Potential Minor Traumatic Brain Injury
Author: Michigan Medicine
Source: The URL where the image is hosted.
License: “CC BY-NC 4.0”

Head CT Guideline for Adult Trauma Patients with Potential Minor Traumatic Brain Injury, Michigan Medicine, Dept of Surgery, “CC BY-NC 4.0”