Criteria for which patients are unlikely to require imaging after head trauma.
- Consider CT Head pending outcome of the rule.
- Consider Neurosurgery Consult as per rule guidelines.
In patients with signs of intracranial hemorrhage, contusion, skull fracture, or other abnormalities diagnosed on brain imaging:
- Always assess ABCs first.
- Neurosurgery consultation.
- Consider hypertonic saline or mannitol after consultation with neurosurgery.
- Admit to neurosurgical ICU for monitoring and further care.
- Providers in more conservative settings could consider applying both rules and choosing to image if either rule suggests that a patient is not completely low risk according to their respective criteria.
- If a trauma patient, with a head injury and loss of consciousness, presenting with a GCS 15 is positive for any of the NOC (age >60, headache, vomiting, alcohol or drug intoxication, persistent anterograde amnesia, visible trauma above the clavicle or seizures) then they require a CT scan of the head to evaluate for intracranial injury.
- If the patient does not have any of the NOC then they can be discharged without undergoing a CT of the head and without the need for any further clinical observation.