Should a patient with a head contusion (traumatic brain injury) and new onset of headache and dizziness be sent to the Emergency Room (ER)?

From the Guidelines

You should send a patient to the emergency room after a head contusion with new onset of headache and dizziness, as these symptoms could indicate a serious head injury requiring immediate medical attention. The combination of recent head trauma with neurological symptoms like headache and dizziness raises concern for potential complications that may not be visible externally, such as a concussion, intracranial hemorrhage, or other traumatic brain injury 1. According to the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC), patients with mild head injury and symptoms like headache, vomiting, or age greater than 64 years are considered high-risk for clinically important brain injury (CIBI) and should undergo CT imaging 1.

Key Considerations

• The CCHR and NOC are clinical decision tools that help identify high-risk patients with mild head injury who require CT imaging 1.
• The presence of headache, vomiting, or age greater than 64 years are high-risk factors for CIBI, as identified by the CCHR 1.
• The NOC also considers drug or alcohol intoxication as a higher-risk feature, but the CCHR relies on a GCS score of <15 or an abnormal level of alertness as risk factors 1.
• Intoxicated patients with minor head injury may require CT imaging, even if they do not meet the high-risk criteria, as the absence of high-risk criteria cannot alone eliminate the need for CT in these patients 1.

Recommendations

• Patients with head contusion and new onset of headache and dizziness should be sent to the emergency room for proper evaluation and management.
• Emergency room physicians can provide guidance on concussion management, determine if observation or admission is necessary, and establish a follow-up plan for recovery.
• CT imaging should be considered in patients with mild head injury and high-risk factors, as identified by the CCHR or NOC.
• Intoxicated patients with minor head injury should be evaluated on a case-by-case basis, and CT imaging should be considered if there is any concern for significant injury.

From the Research

Head Contusion and New Onset of Headache and Dizziness

• A patient with a head contusion and new onset of headache and dizziness should be evaluated for potential intracranial hemorrhage, as this condition can be life-threatening if left untreated 2, 3.
• The presence of headache and dizziness after a head contusion may indicate a more serious condition, such as intracranial hemorrhage, and warrants further evaluation 2, 4.
• Computed tomography (CT) scans of the head are an important component of the initial patient evaluation after blunt head trauma, especially in patients with symptoms such as headache and dizziness 2.
• Patients with mild traumatic brain injury (TBI) and symptoms such as headache and dizziness should be evaluated for potential intracranial hemorrhage, as this condition can occur even in patients with mild TBI 2, 5.

Evaluation and Management

• Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established 5.
• Tools to aid diagnosis and monitor recovery include symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools 5.
• Brief cognitive and physical rest are key components of initial management, and patients should be educated on symptom management and reassured 5.
• Patients with symptoms such as headache and dizziness after a head contusion should be monitored closely for any changes in their condition, and further evaluation and management should be guided by their individual needs 2, 4, 5.

Considerations for Emergency Room Referral

• Patients with head contusion and new onset of headache and dizziness should be referred to the emergency room for further evaluation and management, especially if they have symptoms such as severe headache, vomiting, or confusion 2, 3.
• The emergency room is equipped to provide the necessary evaluation and management for patients with potential intracranial hemorrhage, including CT scans and other diagnostic tests 2, 4.
• Patients with mild TBI and symptoms such as headache and dizziness should be referred to the emergency room if they have any concerns or if their symptoms worsen over time 5.