Clinical Policy: Neuroimaging and
Decisionmaking in Adult Mild Traumatic
Brain Injury in the Acute Setting
October 24, 2001

I. Is there a role for plain film radiographs in the assessment of
acute MTBI in the ED?

Recommendation B: Skull film radiographs are not recommended
in the evaluation of MTBI. Although the
presence of a skull fracture increases the likelihood of
an intracranial lesion, its sensitivity is not sufficient to
be a useful screening test. Indeed, negative findings on
skull films may mislead the clinician.

II. Which patients with acute MTBI should have a noncontrast
head CT scan in the ED?

Recommendation A: A head CT scan is not indicated in
those patients with MTBI who do not have headache,

III. Can a patient with MTBI be safely discharged from the ED
if a noncontrast head CT scan shows no evidence of acute
injury?

Recommendation C: Patients with MTBI who present 6
hours after sustaining the injury, have a normal clinical
examination, and who have a head CT scan that does
not demonstrate acute injury can be safely discharged
from the ED. Patients can be discharged after a shorter
period of observation if they are under the care of a
responsible third party.