Head Trauma, Acute — Imaging Guidelines — Clinical Pathway: Emergency

Acute Head Trauma Clinical Pathway — Emergency Department

Imaging Guidelines

Children < 2 Years

GCS=14
Other signs of altered mental status
Palpable skull fracture
Yes
 
 
CT recommended
No
 
 
Occipital/parietal/temporal scalp hematoma
History of LOC ≥ 5 seconds
Severe mechanism of injury
Not acting normally per parent
Yes
 
 
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
 
 
CT not recommended

Children ≥ 2 Years

GCS=14
Other signs of altered mental status
Basilar skull fracture
Yes
 
 
CT recommended
No
 
 
History of LOC
History of vomiting
Severe mechanism of injury
Severe headache
Yes
 
 
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
 
 
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.