//fpnotebook.com/
Management of Mild Head Injury
Aka: Management of Mild Head Injury, Mild Traumatic Brain Injury, MTBI, Minor Head Injury, Mild Head Injury, Mild Head Trauma
- See Also
- Head Injury
- Concussion
- Mild Head Injury Home Management
- Management of Moderate Head Injury
- Management of Severe Head Injury
- Post-Concussion Syndrome
- Epidemiology
- Mild Traumatic Brain Injury (MTBI) accounts for 75-90% of the 2.8 Million people in U.S. who suffer TBI annually (2013)
- Mild Traumatic Brain Injury is under-reported and likley approaches 3.8 Million in U.S.
- Background
- Mild Traumatic Head Injury is the preferred term for Concussion and Minor Head Injury
- These terms are interchangeable, referring to the same condition
- Criteria
- Glasgow Coma Scale: 13-15 (at two hours)
- Loss of consciousness may have occurred with injury
- Awake and oriented with normal Neurologic Examination
- History
- See Concussion
- See AMPLE History
- Time and mechanism of injury
- Loss of Consciousness
- How long?
- Contiguous with initial injury?
- Level of Consciousness (AVPU)
- Immediately post injury
- Subsequent evaluations
- Amnesia (Retrograde and antegrade)
- Headache
- Seizures
- Exam
- See Trauma Secondary Survey
- Exclude concurrent systemic injury
- Limited Neurologic Exam
- Labs
- Blood Alcohol level
- Urine Drug Screen
- Imaging
- Head CT
- See Head Injury CT Indications in Adults
- See Head Injury CT Indications in Children
- See Pediatric Head Injury Algorithm (PECARN)
- C-Spine XRay as indicated
- Skull XRay Indications
- Penetrating Head Injury
- CT Head not available
- Disposition: Criteria for Hospital Observation
- No CT scan available (and warranted) or abnormal CT Head
- All penetrating head injuries
- Glasgow Coma Scale <15
- History of loss of consciousness
- Deteriorating Level of Consciousness
- Moderate to severe Headache
- Significant Alcohol or drug Intoxication
- Skull Fracture
- Focal neurologic deficit
- Cerebrospinal Fluid leakage (Otorrhea or Rhinorrhea)
- Significant associated injuries
- Persistent Vomiting
- No reliable companion at home or displaced home
- Amnesia
- Anticoagulant use (e.g. Warfarin)
- Risk of delayed Intracranial Hemorrhage (see Head Injury)
- Disposition: Criteria for home observation
- Criteria
- At least six hours after injury
- Normal clinical exam
- Normal Head CT without acute injury
- No findings as above indicating hospital observation
- Studies suggesting safety for discharge in children after blunt Head Trauma and reassuring findings
- Hamilton (2010) Pediatrics 126(1): e33-9 [PubMed]
- Holmes (2011) Ann Emerg Med 58(4): 315-22 [PubMed]
- Studies suggesting safety for discharge in children after blunt Head Trauma with known pre-existing Bleeding Disorders
- Lee (2011) J Pediatr 158(6): 1003-8 [PubMed]
- Delayed Intracranial Hemorrhage following minor head injuries is rare beyond 6 hours in children
- Hamilton (2010) Pediatrics 126(1): e33-9 [PubMed]
- Complications
- Post-Concussion Syndrome
- Management
- See Concussion
- See Mild Head Injury Home Management (includes Head Injury Precautions)
- Follow-up primary care (or Concussion clinic)
- Precautions: Red Flags
- See Concussion Red Flags
- References
- Claudius in Majoewsky (2012) EM:RAP 12(2): 7-8
- Lawler (1996) J Head Trauma Rehabil 11:18-28 [PubMed]
- Jagoda (2002) Ann Emerg Med 40:231-40 [PubMed]