In patients with suspected or radiologically-confirmed TBI, first assess ABC’s and consider neurosurgical/ICU consultation or local policies in regards to fluid management, seizure prophylaxis, hypertonic saline/mannitol, disposition, etc.
Observation for 4-6 hours for those who are not imaged to assess for changes in clinical status.
Reassurance, Education, and Strict Return Precautions for those discharged without imaging.
Follow-up with primary care provider or neurologist and Return to Play/School anticipatory guidance if concussion is suspected.
ciTBI was a rare event (0.9%) and neurosurgical intervention was even more rare (0.1%).
Over 50% of each age cohort did not meet any predictors, and CT imaging is not indicated for the vast majority of these patients as risk of ciTBI was exceedingly low.
Risk of ciTBI was >4% with either of the 2 higher-risk predictors in each age cohort, and imaging is recommended.
For the remaining 4 lower-risk predictors in each cohort the risk of ciTBI is approximately 0.9% per predictor, and CT imaging versus observation is indicated.
Judgment may be based on clinical experience, single versus multiple findings, signs clinical deterioration during observation period, patient age, and parental preference.