Action
Immediate ED transfer for any (Class I):
- GCS score <15
- Altered mental status: agitation, somnolence, repetitive questioning, or slow to verbal response
- Palpable skull fracture or suspected basilar skull fracture
- History of bleeding disorder
Additional ED Transfer Criteria
- LOC
- Severe headache
- Vomiting
- Severe mechanism of injury:
- MVC with ejection
- Death of passenger
- Rollover, struck by vehicle
- Fall >5 ft (1.5 m)
- Head struck by object at high impact
- Outpatient CT reasonable if feasible, patient is cooperative, and CT is indicated due only to LOC
Decision
Are any of the above findings present ?
Yes
Transfer to ED
No
Discharge with detailed written/verbal instructions on symptoms that warrant an ED visit, post-concussion guidance, and instructions on cognitive and physical rest until follow-up occurs
Background
Calculate Pediatric GCS (>2 yo)
- MD Calc (opens browser window)
Eye Opening | Open spontaneously | 4 |
Open to verbal stimuli | 3 | |
Open to pain only | 2 | |
No response | 1 | |
Verbal Response | Oriented / appropriate | 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 |
