Action
Assess for presence of the following findings:
- Occipital or parietal or temporal scalp hematoma
- History of LOC ≥5 s
- Severe mechanism of injury
- Motor vehicle crash with patient ejection, death of another passenger, or rollover
- Pedestrian or bicyclist without helmet struck by a motorized vehicle
- Falls of more than 0.9 m (3 feet)
- Head struck by a high-impact object.
- Not acting normally per parent
Decision
Are any of the findings above present?
Yes
- 0.9% risk of ciTBI (clinically important traumatic brain injury)
- 32.6% of population
Observation versus CT on the basis of other clinical factors including:
- Physician experience
- Multiple versus isolated findings
- Patients with certain isolated findings (ie, with no other findings suggestive of traumatic brain injury), such as isolated LOC, isolated headache, isolated vomiting, and certain types of isolated scalp hematomas in infants older than 3 months, have a risk of ciTBI substantially lower than 1%.
- Worsening symptoms or signs after emergency department observation
- Age <3 months
- Parental preference
No
- <0.02% risk of ciTBI (clinically important traumatic brain injury)
- 53.5% of population
CT not recommended
- Risk of ciTBI exceedingly low, generally lower than risk of CT-induced malignancies. Therefore, CT scans are not indicated for most patients in this group.
