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    Mild Traumatic Brain Injury (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Risk Stratification

    Risk Stratification
    1. A noncontrast head computerized tomography (CT) is indicated in head trauma patients with loss of consciousness or posttraumatic amnesia only if one or more of the following is present: headache, vomiting, age greater than 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicle, posttraumatic seizure, Glasgow Coma Scale (GCS) score less than 15, focal neurologic deficit, or coagulopathy.
    2. A noncontrast head computerized tomography (CT) should be considered in head trauma patients with no loss of consciousness or posttraumatic amnesia if there is a focal neurologic deficit, vomiting, severe headache, age 65 years or greater, physical signs of a basilar skull fracture, Glasgow Coma Scale (GCS) score less than 15, coagulopathy, or a dangerous mechanism of injury. Dangerous mechanism of injury includes ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs.

    Diagnosis

    Imaging
    1. ACEP does not specify any recommendations regarding the role of head magnetic resonance imaging (MRI) over noncontrast computerized tomography (CT) for the evaluation of a patient with mild traumatic brain injury (TBI).
    Biomarkers
    1. In mild traumatic brain injury (TBI) patients without significant extracranial injuries and a serum S-100B level less than 0.1 μg/L measured within 4 hours of injury, consideration can be given to not performing a computerized tomography (CT). This test has not yet received Food and Drug Administration approval for clinical use in the United States.

    Disposition

    Disposition
    1. Patients with an isolated mild traumatic brain injury (TBI) who have a negative head computerized tomography (CT) scan result are at minimal risk for developing an intracranial lesion and therefore may be safely discharged from the emergency department (ED). There are inadequate data to include patients with a bleeding disorder; who are receiving anticoagulation therapy or antiplatelet therapy; or who have had a previous neurosurgical procedure in this population.
    2. Mild traumatic brain injury (TBI) patients discharged from the emergency department (ED) should be informed about postconcussive symptoms.
    What do the icons mean?  
    Research PaperJagoda AS, Bazarian JJ, Bruns JJ, et al. American College of Emergency Physicians. Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting. Ann Emerg Med. 2008;52(6):714-48.