How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.
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
Subscribe to access the complete flowchart to guide your clinical decision making.
Following are the most informative references cited in this paper, as determined by the authors.
2. National Conference of State Legislatures. Traumatic Brain Injury Legislation. Accessed December 15, 2021. (Database of state legistlation )
3. * McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. (Consensus statement)
6. * Cantu RC, Register-Mihalik JK. Considerations for return-to-play and retirement decisions after concussion. PM R. 2011;3(10 Suppl 2):S440-S444. (Consensus paper)
7. Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006 (Blue Book). Accessed December 15, 2021. (Statistical data)
10. * Pandor A, Goodacre S, Harnan S, et al. Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation. Health Technol Assess. 2011;15(27):1-202. (Meta-analysis; 93 studies)
25 * Greenes DS, Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics. 1999;104(4 Pt 1):861-867. (Prospective; 608 patients)
30. * Nishijima DK, Offerman SR, Ballard DW, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012;59(6):460-468.e461-467. (Prospective; 1064 patients)
48. RadiologyInfo.org. Radiation Dose in X-Ray and CT Exams. Accessed December 15, 2021. (Radiation dosage recommendations)
55. Centers for Disease Control and Prevention amd the American College of Emergency Physicians. Updated Mild Traumatic Brain Injury Guideline for Adults. Accessed December 15, 2021. (Guideline)
80. * Fabbri A, Servadei F, Marchesini G, et al. Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury. J Neurol Neurosurg Psychiatry. 2010;81(11):1275-1279. (Secondary analysis; 14,288 patients)
Subscribe to get the full list of 99 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
Keywords: closed head injury, mild CHI, mTBI, traumatic brain injury, Glasgow Coma Score, GCS, intracranial injury, ICI, computed tomography, CT, loss of consciousness, LOC, PECARN, New Orleans Criteria, Canadian Head CT Rule, CATCH, CHALICE
Keith Pochick, MD, FACEP
Novant GoHealth Urgent Care
Melinda Johnson, DNP, APRN, FNP-BC, AGACNP-BC, ENP-C
Vanderbilt University School of Nursing
Patrick O’Malley, MD
Newberry County Memorial Hospital
Patrick O’Malley, MD
Micelle Haydel, MD
Jeffrey J. Bazarian, MD, MPH; Jennifer Roth Maynard, MD; Linda Papa, MD, CM, MSc, CCFP, FRCP(C), FACEP
May 1, 2022
May 1, 2025
4 AMA PRA Category 1 Credits™. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits