II. Signs
- Glasgow Coma Scale: 9-12 (at two hours)
- Confused or somnolent
- Follows simple commands
III. Evaluation: Initial
- Same as in Management of Mild Head Injury
- CT Head in all cases
- Admit all for observation (or Transfer to Neurosurgery)
IV. Evaluation: Inpatient Monitoring
- Frequent neurologic checks
- Follow-up CT Head in 12-24 hours
- Condition deteriorates or
- First CT abnormal or
- Per local protocol before discharge
V. Disposition
- Patient improves (80-90%)
- Discharge after 48 hours
- Follow-up clinic
- Patient deteriorates (10-20%): Not following commands
- Repeat CT Head
- Follow Management of Severe Head Injury protocol