Acute evaluation of an adult with mild head trauma

Mild head trauma is typically defined as head injury due to contact and/or acceleration/deceleration forces and a score on the Glasgow Coma Scale of 13 to 15.

CT: computed tomography; NEXUS: National Emergency X-ray Utilization Study; MRI: magnetic resonance imaging; MR: magnetic resonance.
* Combined from Canadian CT head rule^[1], New Orleans criteria^[2], and NEXUS-II criteria^[3]. Including all features will lead to a very high sensitivity (>99%) and low specificity for identifying a patient with an important brain injury. The features below the dashed line are included in only one of the three validated criteria, while others are included in at least two of them.
¶ If trauma occurred >7 days ago, head MRI without contrast, if available, is more appropriate. If noncontrast images suggest a vascular injury, intravenous contrast may be administered for CT or MR angiography of the head and neck.
Δ These represent general guidelines for when neurosurgical consultation is indicated. It may be prudent to obtain neurosurgical consultation for less severe and other CT abnormalities.
◊ If there is no responsible caregiver at home, consider inpatient observation or CT, if it has not been performed already.

References:

Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357:1391.
Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343:100.
Mower WR, Hoffman JR, Herbert M, et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma 2005; 59:954.

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Acute evaluation of an adult with mild head trauma