ED Pathway for Evaluation/Treatment of Acute Head Trauma

Head Trauma Decision Rules for Children < 2 Years Old

VERY LOW RISK OF INTRACRANIAL INJURY IF ALL OF THE FOLLOWING ARE PRESENT:

Normal Mental Status
Altered mental status is defined as:
  • GCS < 15
  • Agitation
  • Somnolence
  • Slow responses when developmentally appropriate
  • Repetitive questioning
No Hematoma or Isolated Frontal Hematoma  
No LOC or LOC < 5 Seconds  
Non-Severe Injury Mechanism
Severe defined as any of the following:
  • Motor vehicle crash with:
    • Patient ejection
    • Death of another passenger
    • Rollover
  • Pedestrian or bicyclist without helmet struck by a motorized vehicle
  • Falls of > 3 feet
  • Head struck by a high-impact object
No Palpable Skull Fracture  
Acting Normally According to the Parents