Emergency Department Clinical Pathway for the Evaluation/Treatment
of Children with Acute Head Trauma

Child with Acute Head Trauma
< 24 hours after Injury
No suspicion of abuse
Proceed to Resuscitation Room
Decision Rule for Very Low Risk of Intracranial Injury
Children < 2 Years Old
Children ≥ 2 Years Old
All Very-Low Risk Criteria Present
All Very-Low Risk Criteria Not Present

Consider the following:

  • Observe 2-4 hours from time of injury
  • Head CT
Observe 2-4 hrs from time of injury
Discharge home
Review head trauma instructions
If observing
Reassess and/or Review Imaging
Observation and/or
CT Negative and PE Reassuring
CT Positive for Injury
Isolated linear,
skull fracture
injury present
Discharge Home
Review Head Trauma Instructions
  • Normal
    • GCS, mental status
    • Neurologic Exam
  • Tolerating PO
Neurosurgery, Trauma
Admit to PICU, Neurosurgery
Inpatient Trauma Service
  • Criteria for Admission to Inpatient Trauma 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
Posted: December 2010
Revised: March 2023
Authors: F. Nadel, MD; D. Corwin, MD; M. Mittal, MD; C. Jacobstein, MD; J. Lavelle, MD; P. Scribano, DO, MSCE