ED Pathway for Evaluation/Treatment of Acute Head Trauma

Imaging Guidelines

Children < 2 Years

GCS=14
Other signs of altered mental status
Palpable skull fracture
Yes
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CT recommended
No
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Occipital/parietal/temporal scalp hematoma
History of LOC ≥ 5 seconds
Severe mechanism of injury
Not acting normally per parent
Yes
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Observation vs. CT on the basis of other
clinical factors including:

Physician experience
Multiple versus isolated findings
Worsening symptoms or signs after ED observation
Age < 3 months
Parental preference
No
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CT not recommended

Children ≥ 2 Years

GCS=14
Other signs of altered mental status
Basilar skull fracture
Yes
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CT recommended
No
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History of LOC
History of vomiting
Severe mechanism of injury
Severe headache
Yes
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Observation vs. CT on the basis of other
clinical factors including:

Physician experience
Multiple versus isolated findings
Worsening symptoms or signs after ED observation
Parental preference
No
arrow
CT not recommended
Kupperman N, Holmes JF, Dayan PS et al. Identification of children at very low risk of clinically important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70.