Level C recommendations. Do not use clinical decision tools to reliably exclude the need for head CT in adult patients with a minor head injury on anticoagulation therapy or antiplatelet therapy exclusive of aspirin.

Resources

• Canadian CT Head Rule: https://www.mdcalc.com/canadian-ct-head-injury-trauma-rule
• New Orleans/Charity Head Trauma/Injury Rule: https://www.mdcalc.com/new-orleans-charity-head-trauma-injury-rule
• NEXUS Head CT: https://bit.ly/NEXUSHeadCT

2. In the adult ED patient presenting with minor head injury, a normal baseline neurologic examination, and taking an anticoagulant or antiplatelet medication, is discharge safe after a single head CT?

Patient Management Recommendations

Level A recommendations. None specified.

Level B recommendations. Do not routinely perform repeat imaging in patients after a minor head injury who are taking anticoagulants or antiplatelet medication and are at their baseline neurologic examination, provided the initial head CT showed no hemorrhage. Do not routinely admit or observe patients after a minor head injury who are taking anticoagulants or antiplatelet medications, who have an initial head CT without hemorrhage, and who do not meet any other criteria for extended monitoring.

Level C recommendations. Provide instructions at discharge that include the symptoms of rare, delayed hemorrhage after a head injury (consensus recommendation).

Consider outpatient referral for assessment of both fall risk and risk/benefit of anticoagulation therapy (consensus recommendation).

Resources

Discharge instructions and other materials for patients

• CDC Mild Traumatic Brain Injury and Concussion: Information for Adults: https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Patient_Instructions-a.pdf
• CDC educational materials for adults with mTBI: https://www.cdc.gov/traumaticbraininjury/mtbi_guideline.html

Fall risk screening and assessment for clinicians and fall prevention materials for patients

• CDC Algorithm for Fall Risk Screening, Assessment & Intervention: https://www.cdc.gov/steadi/pdf/STEADI-Algorithm-508.pdf
• CDC fall prevention materials for patients: https://www.cdc.gov/steadi/patient.html
• CDC Stay Independent Brochure: https://www.cdc.gov/steadi/pdf/STEADI-Brochure-StayIndependent-508.pdf

3. In the adult ED patient diagnosed with mild traumatic brain injury or concussion, are there clinical decision tools or factors to identify patients requiring follow-up care for PCS or to identify patients with delayed sequelae after ED discharge?

Patient Management Recommendations

Level A recommendations. None specified.

Level B recommendations. None specified.

Level C recommendations. Consider referral for patients with PCS and the following potential risk factors: female sex; previous preconcussive psychiatric history; GCS score <15; etiology of assault, acute intoxication; loss of consciousness; and preinjury psychological history such as anxiety/depression.

Do not use current diagnostic tools (including biomarkers) to reliably predict which patients are at risk for PCS. Provide concussion-specific discharge instructions and selected outpatient referrals of patients at high risk for prolonged PCS (consensus recommendation).