ED Pathway for Evaluation/Treatment of Acute Head Trauma

Triage

1 Critical 2 Acute 3 Urgent 4 Urgent 5 Non-Urgent
  • Mental Status Changes
    • GCS < 14
    • Combative
    • Hard to arouse
    • Inconsolable
  • Bulging fontanelle
  • Other Neurologic Symptoms
    • Ataxia
    • Inability to walk
  • Laceration with uncontrolled bleeding

See Critical Criteria

  • Head trauma with any of the following:

    • Age < 3 months
    • LOC / amnesia
    • Post-traumatic seizures
    • Persistent vomiting (> 2
      episodes of vomiting, or any
      vomiting in the ED)
    • Significant or severe headache
    • GCS = 14
  • PE
    • Irritable / change in behavior
    • Periorbital bruising
    • Bruising over mastoid
    • Fluid or blood from the ear
  • History of coagulopathy
  • Cervical spine tenderness
  • Parathesias
  • Weakness
  • Any suspicion for non-accidental trauma
  • Normal mental status:

  • Any age

    • Large non-frontal hematoma
  • < 12 months
    • Any large hematoma
  • < 2 years
    • Non-frontal hematoma
  • Age >3 months – 2 yrs
    With normal PE, or Small frontal hematoma

  • >2 yrs with minor mechanism, well- appearing, with small hematoma or abrasion

  • Trauma history > 12 hours ago with normal PE