Indications for Immediate Referral of a Patient with Mild Traumatic Brain Injury from the VA/DoD Clinical Practice Guideline

Patient selection: concussion or traumatic brain injury, more than 7 days after the event

Indications for immediate referral:

(1) progressively declining level of consciousness

(2) progressively declining (deteriorating) neurological exam

(3) asymmetrical pupils

(4) seizures

(5) repeated vomiting

(6) motor and/or sensory neurological deficits

(7) double vision

(8) worsening headache

(9) cannot recognize people or disoriented to place

(10) slurred speech

(11) unusual behavior

The presence of one or more indicators should prompt an immediate referral.