Table 3 Summary of the Head Trauma EBG Algorithm© used in the Emergency Department at Boston Children’s Hospital^a

 Head CT recommended if:

Altered mental status (GCS of 14, agitation, sleepiness, slow response or repetitive questioning)

Clinical signs of basilar skull fracture

3 of more of the following predictors are present: Loss of consciousness, history of vomiting, severe injury mechanism, severe headache

 ED observation recommended if:

1–2 of the following predictors are present: Loss of consciousness, history of vomiting, severe injury mechanism, severe headache

 Head CT recommended if:

Altered mental status (GCS of 14, agitation, sleepiness, slow response or repetitive questioning)

Palpable skull fracture

3 of more of the following predictors are present: Non-frontal scalp hematoma, loss of consciousness > 5 s including post-traumatic seizures, severe injury mechanism, acting abnormally per parent

 ED observation recommended if:

1–2 of the following predictors are present: Non-frontal scalp hematoma, loss of consciousness > 5 s including post-traumatic seizures, severe injury mechanism, acting abnormally per parent