Trauma/clinical policy
Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting

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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

Definitions

Since the initial 2002 clinical policy, an analysis of the literature has driven a change in the working definition of mild TBI as it applies to this document. The majority of patients classified as having mild TBI have a GCS score of 15 when they are in the ED, and consequently this group was the focus of the first clinical policy.12 The Canadian CT Head Rule, which has a primary outcome measure of a neurosurgical lesion, includes patients with a GCS of 14 and allows for a period of 2 hours

Methodology

This clinical policy was created after careful review and critical analysis of the medical literature. MEDLINE and the Cochrane Database were searched for articles published from January 2000 through 2007. Specific key words/phrases used in the searches are identified under each critical question. Searches were limited to English-language sources, human studies, and aged 16 years or older. References obtained on the searches were reviewed by panel members (title and abstract) for relevance

Critical Questions

1. Which patients with mild TBI should have a noncontrast head CT scan in the ED?

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    Approved by the ACEP Board of Directors, August 13, 2008

    Supported by the Emergency Nurses Association, September 23, 2008

    This clinical policy was developed by a multidisciplinary panel and funded under contract 200-2007-21367, Centers for Disease Control and Prevention, Coordinating Center for Environmental Health and Injury Prevention, National Center for Injury Prevention and Control, Division of Injury Response.

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