Management of Mild Traumatic Brain Injury in the Emergency Department - Trauma EXTRA Supplement (Trauma CME)

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Publication Date: February 2024 (Volume 27, Supplement 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 02/15/2028.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

With almost 2.9 million people in the United States seeking medical attention for head trauma each year, emergency clinicians face the critical task of efficiently and accurately identifying patients with potentially life-threatening intracranial trauma. This issue of Emergency Medicine Practice: Trauma EXTRA! reviews clinical guidelines, discusses challenges in the care of patients at extremes of ages, and provides indications for imaging. Management and disposition of patients with mild traumatic brain injury that includes neurosurgery consultation, hospital admission for observation or repeat imaging, and discharge precautions are also reviewed.

Case Presentations

A 16-year-old boy presents to the ED, accompanied by his anxious parents, after a collision during a soccer match...

• The teen reports having several minutes of disorientation after the collision.
• He states that his only symptom now is a residual mild headache, but his coach recommended that his parents take him to the ER to be medically cleared before returning to play.
• You consider whether he needs a CT.

A 38-year-old woman is transported to the ED after experiencing a moderate-speed motor vehicle collision...

• She reports that she passed out and then had an episode of nausea.
• She is feeling fine now, but you wonder what the likelihood is that this patient will have clinically important injury on head CT.

A 2-month-old baby is brought to the ED by her parents after rolling off the bed...

• The parents explain that their babysitter reported that the baby accidentally rolled off the bed during a diaper change.
• The baby appears to be sleeping comfortably in her father’s arms, arousing appropriately, but you note a bruise on her left temple.
• You're reluctant to order a CT and question if she needs to be admitted. You also wonder if there might be more to the babysitter’s story.

A 76-year-old man is brought in by EMS from a nearby nursing home for evaluation after a fall from his wheelchair...

• There was no loss of consciousness, but he does have a laceration on his chin.
• EMS personnel report that he is not on anticoagulants, although he does take aspirin and clopidogrel.
• They also note that his current state of “pleasantly confused” is consistent with his baseline mental status.
• You question whether you should order a CT and whether he will need admission or will it be safe to discharge him to the nursing home.

A 57-year-old male presents to the ED with an abrasion on his forehead...

• He tells you that he was drinking alcohol earlier that evening and does not recall how he sustained the injury.
• His CT shows a small focal subarachnoid hemorrhage.
• You think he should be admitted, but the neurosurgeons in your hospital have been reluctant to admit and sometimes don’t even come in to see some patients with small intracranial injuries.
• You wonder if this patient can be discharged safely.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.