Podcast: Play in new window | Download

CT scan without contrast is your test of choice.

Step 1: Consider Your Differential Diagnoses

  • Five high-yield head trauma diagnoses
    • Skull fracture
      • External skull fracture
      • Basilar skull fracture
    • Epidural hematoma
    • Subdural hematoma
    • Traumatic subarachnoid hemorrhage (SAH)
    • Concussion

Step 2: Important Add-ons When Taking History

  • Specific mechanism of injury
  • Loss of consciousness
  • Blood thinners/antiplatelet agents

Step 3: Important Add-ons To Your Physical Exam

  • GCS Score (MDCalc)
  • Pupils
  • Basilar Skull Findings
    • Raccoon eyes
    • Battle sign
    • CSF rhinorrhea
    • Hemotympanum

Step 4: Calculate Canadian Head CT Rule

  • Only apply to patients with…
    • Loss of consciousness
    • Amnesia to event
    • Witnessed disorientation
  • Exclude patients with
    • Blood thinners
    • Seizure(s)
    • Age <16
  • High risk criteria
    • GCS <15 2 hours post injury
    • Suspected open/depressed skull fracture
    • Signs of basilar skull fracture
    • 2 or more episodes of vomiting
    • Age >65
  • “Moderate” risk criteria
    • Retrograde amnesia >30 minutes
    • Dangerous mechanism
      • Fall >3 ft
      • Motor vs pedestrian
      • Ejected from MVA

Additional Reading

  • Canadian CT Head Injury/Trauma Rule (MDCalc)
  • Evaluation and Management of Concussion in Sports (AAN)