Management of Closed Head Injuries in Urgent Care -
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Publication Date: May 2022 (Volume 1, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 05/01/2025.

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

Editor-in-Chief & Update Author

Keith A. Pochick, MD, FACEP

Attending Physician, Novant GoHealth Urgent Care, Charlotte, NC

Urgent Care Peer Reviewer & Charting Commentator

Patrick O’Malley, MD

Attending Physician, Emergency Department, Newberry County Memorial Hospital, Newberry, SC

Urgent Care Peer Reviewer

Melinda Johnson, DNP, APRN, FNP-BC, AGACNP-BC, ENP-C

Assistant Professor of Nursing, Emergency Nurse Practitioner Program, Vanderbilt University School of Nursing, Nashville, TN

Original Author

Micelle Haydel, MD

Associate Professor of Clinical Medicine, Department of Medicine; Residency Director, Section of Emergency Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, LA

Original Peer Reviewers

Jeffrey J. Bazarian, MD, MPH

Professor, Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY

Jennifer Roth Maynard, MD

Assistant Professor, Family Medicine; Program Director, Primary Care Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, FL

Linda Papa, MD, CM, MSc, CCFP, FRCP(C), FACEP

Director of Academic Clinical Research, Attending Physician, Orlando Health; Professor, University of Central Florida College of Medicine, Orlando, FLP

Case Presentations

CASE 1: An 18-year-old boy is brought to the UC clinic by his parents after a head-to-head collision with another player during a soccer game…

The patient was confused for several minutes and now has a resolving headache.
His coach told his parents he “has a concussion” and should go to UC to be checked out...

CASE 2: A 38-year-old woman presents after hitting her head on a cabinet door at home…

The patient was confused for several minutes and now has a resolving headache.
She thinks she may have “blacked out” for a few seconds.
She has some scalp tenderness with mild discoloration and a bit of swelling, but no other current complaints…

CASE 3: A 2-month-old girl is brought in by her parents with a visible bump on her head…

The parents state that their babysitter told them the injury occurred when the baby rolled off the bed during a diaper change.
They also note some inconsistencies in the babysitter’s story and are concerned that they don’t know all of the details of the event…

Introduction

Urgent care (UC) clinicians can expect to see several patients each week who have sustained some type of blunt trauma to the head; many of these patients will present with chief complaints of facial or scalp lacerations and other wounds. The clinical approach to these patients varies widely, and despite the availability of clinical guidelines and decision tools, a substantial number of these patients will undergo ED transfer and/or computed tomography (CT) of the head. The large majority of head CTs performed on patients with mild closed head injury (CHI) will be interpreted as normal,¹ so the challenge for the UC clinician is to quickly identify the small subset of patients who harbor serious intracranial injuries, in order to avoid unwarranted ED transfers as well as to limit costly diagnostic procedures and unnecessary radiation exposure. UC clinicians must accurately document a neurologic baseline for serial examinations and provide discharge instructions that educate patients and families about the potential sequelae of head injury, regardless of how minor the injury appears to be. Further challenges include the rapidly evolving research and recommendations on head injury treatment in the sports arena, with nearly all states having active or pending laws on return to play for youth sports, and full elimination of any same-day return to play after concussive events.²

Accreditation:

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