Management of Infant Head Injury

Risk Stratification

Infants with minor head injury can be safely discharged without CT imaging if they meet ALL of the following criteria: GCS score of 15, normal mental status, no palpable skull fracture, no nonfrontal scalp hematoma, loss of consciousness ≤5 seconds, and acting normally per parents, according to the American College of Radiology 1, 2, 3, 5, 6
The risk of clinically important traumatic brain injury in very low-risk infants is approximately <0.02%, according to the American College of Radiology 1, 5
Infants with GCS 15, normal mental status, no palpable skull fracture BUT with any of the following require either CT or careful observation: loss of consciousness >5 seconds, not acting normally per parent, according to the American College of Radiology 1, 5, 6
The risk of significant injury in intermediate risk infants is approximately 0.9%, according to the American College of Radiology 2, 6

Infants with negative CT scans and normal neurologic examinations can be safely discharged rather than admitted, with a negative predictive value of 100% for neurologic deterioration requiring surgical intervention, according to the American College of Radiology 7, 8
Hospitalization is required for infants with positive CT findings showing intracranial injury, abnormal neurologic examination, or patients on anticoagulation or antiplatelet therapy, according to the American College of Radiology 4, 9

Discharge instructions must be provided in both written and verbal form, written at 6th-7th grade reading level, using font size ≥12 points, according to the American College of Radiology 7, 8, 9, 4
Parents must be educated about expected postconcussive symptoms, including dizziness, nausea, vision problems, sensitivity to noise and light, depression, mood swings, anxiety, irritability, and sleep disturbances, according to the American College of Radiology 4, 9
18% of patients who deteriorate after head injury do so between days 2-7, making delayed onset of symptoms particularly concerning, according to the American College of Radiology 9