Management of Moderate Head Injury

Aka: Management of Moderate Head Injury, Moderate Head Injury, Moderate Head Trauma, Moderate Traumatic Brain Injury, Moderate Closed Head Injury

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II. Signs

  1. Glasgow Coma Scale: 9-12 (at two hours)
  2. Altered Level of Consciousness
    1. Prolonged loss of consciousness (>30 minutes)
    2. Confused or somnolent
    3. Follows simple commands
    4. Restlessness or Agitation
  3. Neurologic deficits
    1. Extremity weakness or numbness
    2. Slurred speech
    3. Coordination loss

III. Evaluation: Initial

  1. Same as in Management of Mild Head Injury
  2. CT Head in all cases
  3. Admit all for observation (or Transfer to Neurosurgery)

IV. Evaluation: Inpatient Monitoring

  1. Frequent neurologic checks
  2. Follow-up CT Head in 12-24 hours
    1. Condition deteriorates or
    2. First CT abnormal or
    3. Per local protocol before discharge

V. Management

  1. See Management of Mild Head Injury
  2. See Management of Severe Head Injury

VI. Disposition

  1. Patient improves (80-90%)
    1. Discharge after 48 hours
    2. Follow-up clinic
  2. Patient deteriorates (10-20%): Not following commands
    1. Repeat CT Head
    2. Follow Management of Severe Head Injury protocol

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