Clinicians should perform brain CT scan on patients that present with suspected brain injury in the acute setting if it is available.
If CT resources are limited, consideration may be given to the use of a set of standardized criteria (e.g., the Canadian CT Head Rule [CCHR], New Orleans Criteria [NOC]) to determine which patients with MTBI receive a brain CT scan. Clinicians should be aware that this practice is associated with a nonzero missed injury rate.
Level 3
Clinicians should not routinely use magnetic resonance imaging (MRI), positron emission tomography, or nuclear magnetic resonance in the clinical management of patients with MTBI at the present time (Level 3).
Patients with an isolated MTBI and a negative brain CT scan result may be discharged from the ED if they have no other injuries or issues requiring hospital admission (Level 2).
Patients taking warfarin who present in the acute setting with an MTBI should have their international normalized ratio (INR) level determined. (Level 3).
Anticoagulated patients with supratherapeutic INR values and a normal initial brain CT scan result remain at significant risk for interval development of intracranial hemorrhage and should be admitted for a period of observation (Level 3).
Patients may be advised that measurable deficits in cognition and memory usually resolve at 1 month but that in 20% to 40% of cases, postconcussive symptoms may persist for 3 months or longer (level 3).
The ability to safely operate a motor vehicle may be impaired for a variable length of time in patients with MTBI. The timing of resumption of driving should be individualized (Level 3).
The timing of returning to work for patients with MTBI should be individualized. Formal neuropsychologic testing can be considered in some cases (Level 3).
Biochemical markers such as S-100, neuron-specific enolase, and serum tau should not be routinely used in the clinical management of patients with MTBI except in the context of a research protocol (Level 3).
