Head trauma (adult)

Diagnosis

CT Guidelines

Inclusion = 'minor head trauma'

AMERICAN HEAD CT RULE

• Minor head trauma = brief LOC after event, then GCS of 15

• CT indicated for:

1. Short term memory deficit (more than amnesia to the event; i.e. persistent anterograde amnesia)
2. Evidence of trauma above clavicles
3. Headache
4. Vomiting
5. Age > 60yrs
6. Drug or EtOH intoxication (clinical impression, not by labs)
7. Seizure post trauma

• Coagulopathy (including coumadin)

CANADIAN HEAD CT RULE

• Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15

• CT indicated for:

1. GCS <15 2hrs post accident
2. Suspected open/depressed skull fx
3. Any sign of basal skull fracture (hemotympanum, racoon eyes, CSF otorrhea/ rhinnorrhea, Battle's sign)
4. Vomiting >2 episodes
5. Age >=65
6. Amnesia >30 mins pror to impact
7. Dangerous mechanism (struck by MVA, ejected from MV, fall from height > 3ft or 5 stairs)

DDx

1. DAI
2. Contusion
3. Epidural
4. Subdural
5. Traumatic SAH
6. Intracerebral
7. Concussion

Treatment

1. Head of bed @ 30 degrees
2. Seizure prophylaxis
3. Maintain CO2 30-35 if suspect herniation
4. maintain CPP (MAP-ICP) 40-65
5. Prevent:
   1. Hypotension
   2. Hypoxia
   3. Anemia
   4. Hyperthermia
   5. Coagulopathy

See Also

Head Trauma (Minor) (Peds)

Source

• (NEJM 7/00, Haydel)
• (Lancet 5/01, Stiell)