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
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
vs.
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,
non-depressed
skull fracture
Intracranial
injury present
Discharge Home
Review Head Trauma Instructions
Yes
  • Normal
    • GCS, mental status
    • Neurologic Exam
  • Tolerating PO
No
Consult
Neurosurgery, Trauma
Admit to PICU, Neurosurgery
or
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: September 2011, April 2012, May 2012, February 2016, May 2017, February 2018, July 2019, February 2020
Authors: M. Zonfrillo, MD, F. Nadel, MD, D. Corwin, MD, M. Mittal, MD, C. Jacobstein, MD, J. Lavelle, MD,
P. Scribano, DO, MSCE