Emergency Medicine Book

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Management of Mild Head Injury

Aka: Management of Mild Head Injury, Mild Traumatic Brain Injury, MTBI, Minor Head Injury
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  1. See Also
    1. Head Injury
    2. Concussion
    3. Management of Moderate Head Injury
    4. Management of Severe Head Injury
    5. Post-Concussion Syndrome
  2. Epidemiology
    1. Mild Traumatic Brain Injury (MTBI) accounts for 75% of the 1.7 Million people in U.S. who suffer traumatic brain injury annually
  3. Criteria
    1. Glasgow Coma Scale: 14-15
    2. Loss of consciousness may have occurred with injury
    3. Awake and oriented with normal Neurologic Examination
  4. History
    1. See AMPLE History
    2. Time and mechanism of injury
    3. Loss of Consciousness
      1. How long?
      2. Contiguous with initial injury?
    4. Level of Consciousness (AVPU)
      1. Immediately post injury
      2. Subsequent evaluations
    5. Amnesia (Retrograde and antegrade)
    6. Headache
    7. Seizures
  5. Exam
    1. See Trauma Secondary Survey
    2. Exclude concurrent systemic injury
    3. Limited Neurologic Exam
  6. Labs
    1. Blood Alcohol level
    2. Urine Drug Screen
  7. Imaging
    1. Head CT
      1. See Head Injury CT Indications in Adults
      2. See Head Injury CT Indications in Children
      3. See Pediatric Head Injury Algorithm (PECARN)
    2. C-Spine XRay as indicated
    3. Skull XRay Indications
      1. Penetrating Head Injury
      2. CT Head not available
  8. Disposition: Criteria for Hospital Observation
    1. No CT scan available (and warranted) or abnormal CT Head
    2. All penetrating head injuries
    3. Glasgow Coma Scale <15
    4. History of loss of consciousness
    5. Deteriorating Level of Consciousness
    6. Moderate to severe Headache
    7. Significant Alcohol or drug intoxication
    8. Skull Fracture
    9. Focal neurologic deficit
    10. Cerebrospinal Fluid leakage (Otorrhea or Rhinorrhea)
    11. Significant associated injuries
    12. Persistent Vomiting
    13. No reliable companion at home or displaced home
    14. Amnesia
  9. Disposition: Criteria for home observation
    1. Criteria
      1. At least six hours after injury
      2. Normal clinical exam
      3. Normal Head CT without acute injury
      4. No findings as above indicating hospital observation
    2. Studies suggesting safety for discharge in children after blunt Head Trauma and reassuring findings
      1. Hamilton (2010) Pediatrics 126(1): e33-9
      2. Holmes (2011) Ann Emerg Med 58(4): 315-22
    3. Studies suggesting safety for discharge in children after blunt Head Trauma with known pre-existing Bleeding Disorders
      1. Lee (2011) J Pediatr 158(6): 1003-8
  10. Complications
    1. Post-Concussion Syndrome
  11. Management: Discharge instructions
    1. See Head Injury Precautions
  12. Precautions: Red Flags
    1. See Concussion Red Flags
  13. References
    1. Claudius in Majoewsky (2012) EM:RAP 12(2): 7-8
    2. Lawler (1996) J Head Trauma Rehabil 11:18-28
    3. Jagoda (2002) Ann Emerg Med 40:231-40

Brain Concussion (C0006107)

Definition (NCI) A violent jar or shock, or the condition which results from such an injury.
Definition (MEDLINEPLUS)

A concussion is a type of brain injury. It's the most minor form. Technically, a concussion is a short loss of normal brain function in response to a head injury, but people use the term to describe any minor injury to the head or brain. Concussions are a common type of sports injury. You can also suffer from one if you suffer a blow to the head or hit your head after a fall.

After a concussion, you may have a headache or neck pain. You may also experience nausea, ringing in your ears, dizziness, or tiredness. You may feel dazed or not your normal self for several days or weeks after the injury. Consult your health professional if you notice any of your symptoms getting worse, or if you have more serious symptoms such as seizures or trouble walking or sleeping.

NIH: National Institute of Neurological Disorders and Stroke
Definition (MSH) A nonspecific term used to describe transient alterations or loss of consciousness following closed head injuries. The duration of UNCONSCIOUSNESS generally lasts a few seconds, but may persist for several hours. Concussions may be classified as mild, intermediate, and severe. Prolonged periods of unconsciousness (often defined as greater than 6 hours in duration) may be referred to as post-traumatic coma (COMA, POST-HEAD INJURY). (From Rowland, Merritt's Textbook of Neurology, 9th ed, p418)
Definition (NCI) A violent jar or shock, or the condition which results from such an injury.
Concepts Injury or Poisoning (T037)
MSH D001924
ICD9 850.9, 850
ICD10 S06.0, S06.00, S06.0X9, S06.0X
SnomedCT 157321003, 209832007, 81371004, 110030002
English Brain Concussions, Concussion, Brain, BRAIN, CONCUSSION, Concussion NOS, Concussion, unspecified, concussion (diagnosis), concussion, Cerebral Concussion, Cerebral Concussions, Concussion, Cerebral, Commotio Cerebri, Concussion NOS (disorder), CONCUSSION, Brain Concussion [Disease/Finding], Concussive injury, brain concussion, cerebral concussion, commotio, concussion disorder, brain concussions, concussions, Brain Concussion, Concussion, Commotio cerebri, Cerebral concussion, Brain concussion, Commotio, Concussion (disorder), Concussion injury of brain (disorder), Concussion injury of brain, brain; blast, brain; commotio, brain; concussion, cerebral; concussion, cerebri; commotio, commotio cerebri, commotio; brain, concussion; brain, concussion; cerebral, Concussion (Brain), Injury;concussion;head
Italian Concussione, Concussione non specificata, Commotio cerebri, Commozione cerebrale
Dutch commotio cerebri, hersenschudding, niet-gespecificeerd, cerebraal; concussie, cerebri; commotie, commotie; hersenen, concussie; cerebraal, concussie; hersenen, hersenen; commotie, hersenen; concussie drukgolf, hersenen; concussie, hersenschudding, Hersenschudding, Commotio cerebri
French Commotion , non précisée, Commotion cerebrale, Commotion de l'encéphale, Commotion cérébrale, Commotion encéphalique, Commotion
German Gehirnerschuetterung, unspezifisch, Gehirnerschuetterung, Commotio cerebri, Gehirnerschütterung
Portuguese Concussão NE, Comoção cerebral, Concussão Encefálica, Concussão Cerebral, Comoção Encefálica, Comoção Cerebral, Traumatismo craniano/lesao intrac, Concussão
Spanish Conmoción no especificada, Conmoción cerebral, Conmocion Encefalica, Conmoción Encefálica, Conmocion Cerebral, Conmoción Cerebral, Concusión Encefálica, Concusión Cerebral, Concusion Encefalica, Concusion Cerebral, Concussion, Conmocion cerebral/concusion, conmoción (trastorno), conmoción(trastorno), concusión cerebral (trastorno), concusión cerebral, concusión, conmoción cerebral (trastorno), conmoción cerebral, conmoción, SAI (trastorno), conmoción, SAI, conmoción, lesión cerebral por concusión, Conmoción
Japanese 脳振盪、詳細不明, ﾉｳｼﾝﾄｳ, ﾉｳｼﾝﾄｳｼｮｳｻｲﾌﾒｲ, 脳振とう, 脳振とう症, 脳振盪, 脳振盪症, 脳震とう, 脳震盪
Swedish Hjärnskakning, HJARNSKAKNING
Czech mozek - komoce, Otřes mozku, blíže neurčený, Komoce mozková, Otřes mozku, otřes mozku
Finnish Aivotärähdys, AIVOTARAHDYS
Russian MOZGA GOLOVNOGO SOTRIASENIE, МОЗГА ГОЛОВНОГО СОТРЯСЕНИЕ
Norwegian HJERNERYSTELSE s06.0
Danish Hjernerystelse
Hungarian agyrazkodas, Commotio, nem meghatározott, Commotio cerebri, Commotio
Korean 뇌진탕
Croatian POTRES MOZGA
Basque BURMUIN KORDOKADURA
Hebrew zaazua moax
Polish Wstrząśnienie mózgu
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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