Patient selection: child less than 2 years old with blunt head injury and an initial Glasgow coma score 14 or 15, seen in Emergency Department within 24 hours
Outcome: clinically important traumatic brain injury (ciTBI)
High risk indications::
(1) GCS 14
(2) altered mental status
(3) palpable skull fracture
Intermediate risk – both of the following:
(1) one or more of the following:
(1a) occipital, parietal and/or temporal hematoma
(1b) loss of consciousness >= 5 seconds
(1c) severe mechanism of injury (ejection after motor vehicle crash, death of another passenger, rollover, pedestrian hit by motorized vehicle, bicyclist without helmet hit by motorized vehicle, fall > 0.9 meters, head struck by a high-impact object)
(1d) not acting normal according to paraents
(2) one or more of the following:
(2a) multiple findings
(2b) worsening symptoms
(2c) age < 3 months
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High Risk
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Intermediate Risk
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Evaluation
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present
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NA
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head CT scan
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absent
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both present
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head CT scan
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absent
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primary findings but not secondary
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observation
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absent
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primary absent
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CT scan not recommended
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