Table 1:

Decision rule comparison of predictor variables, modified after Lyttle et al16,1820

Mechanism of injury
    Severe mechanism of injury (MVC with patient ejection, death of another passenger, or rollover; pedestrian/bicyclist without helmet struck by motorized vehicle; falls >1.5 m [if younger than 2 yr, fall >0.9 m]; head struck by high-impact object)Dangerous mechanism of injury (eg, MVC; fall from elevation of ≥3 feet [≥0.91 m] or 5 stairs; fall from bicycle with no helmet).High-speed road traffic collision: pedestrian, cyclist, occupant (>40 miles/h or 64 km/h); fall >3 m in height; high-speed injury from projectile or object
    Any or suspected LOCHistory of worsening headacheWitnessed LOC >5 min
    History of vomiting≥3 Vomits after head injury (discrete episodes)
    If age younger than 2 yearsAmnesia (anterograde/retrograde >5 min)
        LOC ≥5 secSuspicion of nonaccidental injury
    Not acting normally per parentSeizure in patient with no history of epilepsy
Physical examination
    Clinical signs of basilar skull fractureGCS < 15, two hours after injuryGCS < 14, pediatric GCS < 15 if younger than 1 yr of age
    If younger than 2 years age:Irritability on examinationAbnormal drowsiness (more than that expected by examining doctor)
        Palpable or unclear skull fractureAny sign of basal skull fracturePositive focal neurology
        Occipital, parietal, or temporal scalp hematomaSuspected open or depressed skull fractureSigns of basal skull fracture
        Large boggy scalp hematomaSuspicion of penetrating or depressed skull injury or tense fontanelle
Presence of bruise/swelling/laceration >5 cm if younger than 1 yr of age
  • Note:—MVC indicates motor vehicle collision; LOC, loss of consciousness.