Action
Assess for:
- Severe headache
- Age ≥65 years
- Physical signs of basilar skull fracture
- Coagulopathy, bleeding disorder, or on anticoagulant or anti-platelet agent (other than low-dose aspirin)
- Dangerous mechanism of injury:
- Ejection from a motor vehicle
- Pedestrian struck
- Fall from a height >3 ft (0.9 m) or 5 steps
Decision
Are any of the above findings present?
Yes
- Transfer to ED or arrange STAT outpatient non-contrast head CT (Class I)
- Primary ED transfer for higher-risk patients:
- On anticoagulant or anti-platelet agent
- Bleeding disorder
- Intoxication
- Persistent vomiting
- Dangerous mechanism of injury
- Severe headache
- Signs of basilar skull fracture
No
- No CT (Class I)
- Discharge with appropriate written and verbal instructions on symptoms that would prompt an ED visit, as well as education on post–concussion syndrome (Class II)
If obtaining outpatient CT