II. Signs

  1. Glasgow Coma Scale: 9-12 (at two hours)
  2. Confused or somnolent
  3. Follows simple commands

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. 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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