Greenberg et al reported the KIIDS-TBI tool for evaluating a pediatric patient with mild traumatic brain injury (TBI) and intracranial injury. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in the United States.

Patient selection: pediatric patient (<= 18 years) with mild traumatic brain injury, Glasgow coma scale 13, 14 or 15 and intracranial injury on imaging studies


High acuity:

(1) midline shift

(2) depressed skull fracture that is depressed >= thickness of cranial bone

(3) epidural hematoma


Intermediate acuity:

(4) Glasgow coma scale< 15


Low acuity:

(5) extra-axial hematoma (unable to determine if subdural or epidural)

(6) subdural hematoma

(7) cerebral contusion


The level of acuity may be modified based on:

(1) patient condition (improving or worsening)

(2) size and location of the intracranial lesion

(3) physician experience


A low acuity patient with findings to suggest upcoding can be managed by observation in a community hospital under certain circumstances.

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