Source: AAFP 2012
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Guidelines from the American College of Emergency Physicians* |
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Imaging is indicated in patients with a loss of consciousness or amnesia if at least one of the following is present: headache (diffuse), vomiting, age older than 60 years, intoxication, deficits in short-term memory, evidence of trauma above the clavicle, seizures, GCS score of less than 15, focal neurologic deficits, coagulopathy |
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Imaging is indicated in patients with no loss of consciousness or amnesia if at least one of the following is present: focal neurologic deficit, vomiting, severe headache, age older than 65 years, signs of basilar skull fracture, GCS score of less than 15, coagulopathy, significant mechanism of injury (e.g., ejection from vehicle, pedestrian struck by vehicle, fall from a height greater than 3 ft or five stairs) |
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Guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians† |
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Perform imaging in patients with loss of consciousness of greater than 60 seconds, evidence of skull fracture, or focal neurologic findings |
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Consider imaging or observation if patient has brief loss of consciousness |
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Note that nonspecific signs (e.g., immediate seizures, headache, vomiting, lethargy) increase the likelihood of intracranial injury, but have very limited predictive value |
*—Applies to patients older than 16 years who present to the emergency department within 24 hours of a nonpenetrating head injury and have a GCS score of 14 or 15.
†—Applies to patients two to 20 years of age who present to the emergency department within 24 hours of an isolated closed head injury.