ED Pathway for Evaluation/Treatment
of Acute Head Trauma
Child with Acute Head Trauma <24 hours after Injury
No suspicion of abuse
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Triage
(Critical/Acute/Urgent)
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Critical
Proceed to Resuscitation Room
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DECISION RULE FOR VERY LOW RISK OF INTRACRANIAL INJURY
Children < 2 Years Old
Children ≥ 2 Years Old
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ARE ALL VERY LOW RISK CRITERIA PRESENT?
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YES
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Consider the following:
Observe 2-4 hrs from time of injury
vs.
Discharge home
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Discharge with one of the
following instructions:
  • Head injury (Minor)
NO
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Consider the following:

  • Observation 2-4 hrs from time of injury
  • Head CT
  • Skull X-rays (if < 2 years old)
Observation and/or imaging negative
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CT positive for significant intracranial injury
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YES
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NO
Consult Neurosurgery and Trauma Surgery
Isolated skull fracture
or
Significant concussive symptoms
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Meets Criteria for Admission to
Trauma Inpatient Service
Isolated, non-epidural hemorrhage < 1 cm in diameter
GCS = 15, normal mental status
Non focal neurologic examination
No other trauma requiring ICU care
No history of coagulopathy
ED and Trauma Attending agree
YES
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Admit to Surgical Floor on
Trauma Inpatient Service
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NO
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Admit to PICU, Neurosurgery or Trauma Service
Posted : December 2010
Revised : September 2011, April 2012, May 2012
Authors : M. Zonfrillo, MD, F. Nadel, MD, C. Jacobstein, MD, J. Lavelle, MD