Traumatic Brain Injury - ICU Management

Mild TBI (GCS 13-15) with positive CT findings, WITHOUT anticoagulation/antithrombotic therapy, or coagulopathy

* Stat non-contrast CT head and notify Neurosurgery immediately if change in neurological exam.

Mild TBI (GCS 13-15) with positive CT findings, WITH anticoagulation/antithrombotic therapy, or coagulopathy

Non-contrast CT head on admit
Q1H neurological exams
Repeat non-contrast CT head at 24 hours, or earlier if recommended by Neurosurgery in cases at high risk of bleed expansion

* Stat non-contrast CT head and notify Neurosurgery immediately if change in neurological exam.

Moderate/Severe TBI (GCS <13) with positive CT findings, WITH or WITHOUT anticoagulation/antithrombotic therapy or coagulopathy

Non-contrast CT head on admit
Q1H neurological exams
Repeat non-contrast CT head at 6 hours or earlier if recommended by Neurosurgery in cases at high risk of bleed expansion
Order additional repeat CT head per Neurosurgery recommendations

* Stat non-contrast CT head and notify Neurosurgery immediately if change in neurological exam.

NOTE: Repeat head CT scan is NOT routinely required following initiation of VTE prophylaxis for the sole purpose of repeat evaluation

MINIMUM REQUIRED NEUROLOGICAL EXAMINATION:

GCS (motor, verbal, eye and total)
Pupils
Motor
- Document limitations of motor exam, for example, extremity fractures.
- Attempt to obtain motor response distal to injury
Any other nuances should be specified by the neurosurgery team (i.e. other, potentially subtle, neurologic findings/changes that would be considered particularly concerning in the patient, which should be monitored for and documented, and why.)

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Traumatic Brain Injury - ICU Management, Michigan Medicine, Dept of Surgery, “CC BY-NC 4.0”