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

Consider the following:

  • Observe 2-4 hours from time of injury
  • Head CT
  • Skull X-rays
    • Age < 2years w/parietal/occipital hematoma or
    • Age < 2 months
Observation and/or imaging negative
CT positive for significant intracranial injury
YES
NO
Consult Neurosurgery and Trauma Surgery
Isolated linear, non-depressed
skull fracture present
GCS 15, normal neuro exam
Tolerating PO
NO
YES
Meets criteria for admission to
Trauma Inpatient Service
  • Isolated, non-epidural hemorrhage
    < 5 mm 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
Admit to
Surgical Floor
on Trauma
Inpatient Service
Discharge
NO
Admit to PICU, Neurosurgery
or Trauma Service
Posted: December 2010
Revised: September 2011, April 2012, May 2012, February 2016, May 2017, February 2018, July 2019
Authors: M. Zonfrillo, MD, F. Nadel, MD, D. Corwin, MD, M. Mittal, MD, C. Jacobstein, MD, J. Lavelle, MD,
P. Scribano, DO, MSCE