After Head CT algo v1

  • Head CT Performed
    • Normal Head CT
      • Notes
        • No Findings
        • Incidental findings (e.g., cyst)
      • Discharge Criteria
        • Check
          • Normal mental status
          • Non-focal neuro exam
          • Ability to tolerate fluids by mouth
          • No social concerns
          • Not < 2 months with isolated skull fracture
        • Yes
          • Discharge to home with:
            • Head injury discharge instructions
            • Review reasons to return for care
            • Primary Care follow-up
            • If patient has a concussion, prescribe cognitive and physical rest until cleared by MD
        • No
          • Admit to Medical Service
    • Isolated Non-displaced Skull Fracture
      • Notes
        • Consider social work evaluation (especially if < 2 years)
        • If social work evaluation causes concern, then off algorithm
      • Discharge Criteria
        • Check
          • Normal mental status
          • Non-focal neuro exam
          • Ability to tolerate fluids by mouth
          • No social concerns
          • Not < 2 months with isolated skull fracture
        • Yes
          • Discharge to home with:
            • Head injury discharge instructions
            • Review reasons to return for care
            • Primary Care follow-up
            • If patient has a concussion, prescribe cognitive and physical rest until cleared by MD
        • No
          • Admit to Medical Service
    • Positive Head CT
      • Notes
        • Depressed skull fracture
        • Intracranial injury: subdural, epidural, subarachnoid hemorrhage or intraparenchmal hemorrhage, diffuse axonal injury, cerebral edema or midline shift
        • Non-isolated skull fracture
      • Consult neurosurgery
  • No Head CT Performed
    • Discharge to home with:
      • Head injury discharge instructions
      • Review reasons to return for care
      • Primary Care follow-up
      • If patient has a concussion, prescribe cognitive and physical rest until cleared by MD

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