Action
Assess for:
- GCS score decreases to <15
- Focal neurological deficit
- Coagulopathy, bleeding disorder, or on anticoagulant or anti-platelet agent (other than low-dose aspirin)
- Age >60 years
- Intoxication
- Vomiting
- Moderate or severe headache
- Seizure
- Anterograde amnesia
- Physical evidence of trauma above clavicles
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)
Background
Calculate GCS
- MD Calc (opens browser window)
Eye Opening | Open spontaneously | 4 |
Open to verbal command | 3 | |
Open to pain only | 2 | |
No eye opening | 1 | |
Verbal Response | Oriented | 5 |
Confused | 4 | |
Inappropriate words | 3 | |
Incomprehensible words / sounds | 2 | |
No response | 1 | |
Motor Response | Obeys commands | 6 |
Localizes pain | 5 | |
Withdraws to pain | 4 | |
Flexor posturing to pain | 3 | |
Extensor posturing to pain | 2 | |
No response | 1 |
