Mild traumatic brain injury management
✅ Initial Assessment
Evaluate for loss of consciousness, amnesia, vomiting, seizures, headache, intoxication, anticoagulant use, or neurological symptoms.
Perform a detailed neuro exam and screen for red flags (e.g., focal deficit, worsening headache, confusion).
🏥 Emergency Department Disposition
Discharge Home if:
GCS 15
Normal CT (or no indication for CT)
No worsening symptoms or comorbid risks
A responsible adult is available at home
Observation/Admission if:
CT shows abnormalities (e.g., small hemorrhages)
The patient is on anticoagulants
Significant medical comorbidities
Lack of social support or substance use concerns
📋 Outpatient Management
Cognitive and Physical Rest (24–48 hours): Avoid screens, reading, and strenuous activity early on.
Gradual Return to Activities: Stepwise return to school, work, and sports per symptom tolerance.
Symptom Monitoring:
Headache
Dizziness
Sleep disturbances
Difficulty concentrating
Education: Explain expected course, symptom resolution, and red flags that require re-evaluation.
Follow-Up: Typically within 1–2 weeks, especially if symptoms persist.
⚠️ Red Flags for Reassessment
Worsening headache or vomiting
Focal neurological deficits
Seizures
Confusion or altered mental status
Balance problems
⏳ Post-Concussion Syndrome (PCS)
Persistent symptoms > 4 weeks
Multidisciplinary care may include neurology, neuropsychology, physiotherapy, and vestibular rehab
📚 Key Guidelines & Resources
CDC Heads Up Initiative
Brain Trauma Foundation Guidelines
Concussion in Sport Group (CISG) Consensus Statements
National Institute for Health and Care Excellence (NICE) TBI guidelines
Previous studies have indicated that there is no consensus about the management of mild traumatic brain injury (mTBI) at the emergency department (ED) and during hospital admission 1).
Management should begin with removal from risk if a concussion is suspected, and once diagnosis is made, education and reassurance should be provided. Once symptoms have resolved, a graded return-to-play protocol can be implemented with close supervision and observation for return of symptoms. Management should be tailored to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary 2).