title: Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting.
abstract: This clinical policy provides evidence-based recommendations on select issues in the management of adult patients with mild traumatic brain injury (TBI) in the acute setting. It is the result of joint efforts between the American College of Emergency Physicians and the Centers for Disease Control and Prevention and was developed by a multidisciplinary panel. The critical questions addressed in this clinical policy are: (1) Which patients with mild TBI should have a noncontrast head computed tomography (CT) scan in the emergency department (ED)? (2) Is there a role for head magnetic resonance imaging over noncontrast CT in the ED evaluation of a patient with acute mild TBI? (3) In patients with mild TBI, are brain specific serum biomarkers predictive of an acute traumatic intracranial injury? (4) Can a patient with an isolated mild TBI and a normal neurologic evaluation result be safely discharged from the ED if a noncontrast head CT scan shows no evidence of intracranial injury? Inclusion criteria for application of this clinical policy's recommendations are nonpenetrating trauma to the head, presentation to the ED within 24 hours of injury, a Glasgow Coma Scale score of 14 or 15 on initial evaluation in the ED, and aged 16 years or greater. The primary outcome measure for questions 1, 2, and 3 is the presence of an acute intracranial injury on noncontrast head CT scan; the primary outcome measure for question 4 is the occurrence of neurologic deterioration.
authors.forename: Andy S
authors.initials: AS
authors.lastname: Jagoda
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Bazarian
authors.forename: John J
authors.initials: JJ
authors.lastname: Bruns
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Cantrill
authors.forename: Alisa D
authors.initials: AD
authors.lastname: Gean
authors.forename: Patricia Kunz
authors.initials: PK
authors.lastname: Howard
authors.forename: Jamshid
authors.initials: J
authors.lastname: Ghajar
authors.forename: Silvana
authors.initials: S
authors.lastname: Riggio
authors.forename: David W
authors.initials: DW
authors.lastname: Wright
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
authors.forename: Aric
authors.initials: A
authors.lastname: Bakshy
authors.forename: Paula
authors.initials: P
authors.lastname: Burgess
authors.forename: Marlena M
authors.initials: MM
authors.lastname: Wald
authors.forename: Rhonda R
authors.initials: RR
authors.lastname: Whitson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000145:classification* / Q000503:physiopathology; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D015600:Glasgow Coma Scale; D017408:Guidelines as Topic; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012042:Registries; D055815:Young Adult