Management of Mild Head Injury

1. See Also
   1. Head Injury
   2. Concussion
   3. Management of Moderate Head Injury
   4. Management of Severe Head Injury
2. Criteria
   1. Glasgow Coma Scale: 14-15
   2. Loss of consciousness may have occurred with injury
   3. Awake and oriented with normal Neurologic Examination
3. 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
4. Exam
   1. See Trauma Secondary Survey
   2. Exclude concurrent systemic injury
   3. Limited Neurologic Exam
5. Labs
   1. Blood Alcohol level
   2. Urine Drug Screen
6. Radiology
   1. Head CT
      1. See Head Injury CT Indications in Adults
      2. See Head Injury CT Indications in Children
   2. C-Spine XRay as indicated
   3. Skull XRay Indications
      1. Penetrating Head Injury
      2. CT Head not available
7. 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. SkullFracture
   9. Focal neurologic deficit
   10. Cerebrospinal Fluid leakage (Otorrhea or Rhinorrhea)
   11. Significant associated injuries
   12. No reliable companion at home or displaced home
   13. Amnesia
8. Disposition: Criteria for home observation
   1. At least six hours after injury
   2. Normal clinical exam
   3. Normal Head CT without acute injury
9. Management: Discharge instructions
   1. See Head Injury Precautions
10. References
    1. Lawler (1996) J Head Trauma Rehabil 11:18-28
    2. Jagoda (2002) Ann Emerg Med 40:231-40