All patients with suspected traumatic brain injury should be assessed and stabilised using an Airway, Breathing, Circulation (ABC) approach.
An urgent (within 1 hour) computed tomographic (CT) head scan should be performed in those identified as having a risk factor for brain injury (i.e., intracranial complication). All patients on anticoagulant treatment and with no indications for urgent CT scan need to be scanned within 8 hours of the head injury.
Diagnosis of mild traumatic brain injury is clinical. Selected patients may be admitted to hospital for observation.
Patients with no indications for CT scan or with a normal CT scan may be discharged from the accident and emergency department if there is somebody suitable at home to supervise them.
The need for analgesia and antiemetics should be considered in all patients.
A mild traumatic brain injury is a head injury due to a direct blow to the head or deceleration of the head from an impulsive force that results in a change in mental status.
This topic covers the acute management of mild traumatic brain injury in adults and children.
History and exam
Key diagnostic factors
- history of blunt trauma to the head or acceleration/deceleration forces
- Glasgow Coma Scale score of 13-15 thirty minutes or later post-injury and transient neurological abnormalities
- risk factors
Other diagnostic factors
- disturbed gait/balance or dizziness
- memory difficulties or amnesia
- neck pain
- normal neurological examination
- abnormalities on cognitive assessment
- head injury
- previous brain trauma
- alcohol and drug misuse
1st investigations to order
- clinical diagnosis
Investigations to consider
- CT head
- MRI head
- clotting screen
- skull x-ray
- alcohol screen (breath and blood)
suspected traumatic brain injury (any severity)
confirmed mild traumatic brain injury: in hospital
confirmed mild traumatic brain injury: in the community
Matthew Jones, MD, FRCP
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
MJ is an honorary senior lecturer at the University of Manchester.
MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
Luke C. Henry, PhD
Department of Neurological Surgery
Senior Clinical Neuropsychologist
University of Pittsburgh
LCH declares that he has no competing interests.
Maria Twichell, MD
Assistant Clinical Professor
General Rehabilitation Unit
UPMC Physical Medicine and Rehabilitation
University of Pittsburgh Medical Center
MT declares that she has no competing interests.
Alan Carson, MB ChB, MPhil, MD, FRCPsych, FRCP
Honorary Professor of Neuropsychiatry
University of Edinburgh
AC is treasurer to the Functional Neurological Disorders Society. He is associate editor of the Journal of Neurology, Neurosurgery and Psychiatry, and has contributed to the Scottish Intercollegiate Guidelines Network concussion guidelines. He developed a free-access, not-for-profit self-help website for patients after mild brain injury (http://www.headinjurysymptoms.org). He has received travel and accommodation expenses, but not payments, from professional organisations for speaking at their educational meetings including talks on concussion and brain injury. He gives independent testimony in court on a range of neuropsychiatric topics including brain injury. AC contributed content to a concussion application still in development.
Section Editor, BMJ Best Practice
HDC declares that she has no competing interests.
Head of Editorial, BMJ Best Practice
AE declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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