From the Guidelines
The patient should be closely monitored for up to 72 hours, with rest and observation for red flags such as loss of consciousness, concussion signs, nausea, vomiting, blurry vision, dizziness, or worsening headache, and a CT scan should be considered if any of these symptoms develop. The management of a 31-year-old female with a minor head injury, presenting with a localized headache and hematoma after a fall, with no immediate red flags for intracranial injury, and no known allergies or anticoagulant (blood thinner) use, should prioritize careful observation and monitoring for potential complications.
- The Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) are two well-established clinical decision tools that can help identify patients at high risk for clinically important brain injury or neurosurgical intervention 1.
- A study by Stiell et al. found that the CCHR had a sensitivity of 100% and a specificity of 68.7% for predicting the need for neurologic intervention, while the NOC had a sensitivity of 100% and a specificity of 25% 1.
- Another study by Mower et al. found that the NEXUS Head CT decision instrument had a sensitivity of 100% and a specificity of 24.9% for predicting the need for neurosurgical intervention 1.
- The patient's presentation, with a localized headache and hematoma, but no immediate red flags, suggests a low-risk scenario, but close monitoring is still necessary to detect any potential complications that may arise.
- The patient should be advised to seek immediate medical attention if any red flags develop, such as loss of consciousness, concussion signs, nausea, vomiting, blurry vision, dizziness, or worsening headache.
- The hematoma size should be monitored, and the patient should seek in-person medical evaluation if concerned.
- This approach is supported by a study by af Geijerstam et al., which found that a CT strategy is a safe way to triage mild TBI patients for admission and discharge 1.