High-risk | Patients with at least one of the following: GCS ≤ 13 or drop of 2 points since arrival, focal neurologic signs, loss of consciousness > 5 min, signs of basal or complicated skull fracture. |
CT recommended. | |
Moderate-risk | Patients who do not present any of the above reported features and whose risk of intracranial injury and subsequent management (CT or observation alone) is differentiated according to the presence of specific clinical predictors or the combination given by the severity of trauma mechanism with the presence and site of large scalp hematoma (the last feature considered only for children < 2 years). |
CT is recommended if: | |
For children < 2 years amnesia is introduced alongside the other original predictors and, in the presence of isolated vomiting, CT is suggested if there was repetitive vomiting (more than 4 episodes) or persistent vomiting for more than 6 h after head trauma and a negative personal history for recurrent vomiting or motion sickness. | |
Observation in the ED is recommended if: | |
The recommended duration of observation in the ED for patients who did not undergo a CT is at least 6 h for trauma and at least 12 h for infants < 6 months. | |
Low-risk | Patients with absence of any of the features of the high- and moderate-risk groups and the possible presence of up to 4 episodes of vomiting immediately after trauma, mild headache confined to site of trauma, or loss of consciousness of only a few seconds. |
No imaging recommended. |