MRA Head and Neck There is no relevant literature to support the use of MR angiography (MRA) in the initial imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of functional MRI (fMRI) in the initial imaging evaluation of acute head trauma. MRI Head There is no relevant literature to support the use of MRI in the initial imaging evaluation of acute head trauma (please see Variant 4 for discussion of MRI after negative head CT). MRI Head with DTI There is no relevant literature to support the use of diffusion tensor imaging (DTI) in the initial imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the initial imaging evaluation of acute head trauma (replaced by CT, which is more sensitive for neurosurgical lesions). Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the initial imaging evaluation of acute head trauma. Head Trauma military personnel, per Department of Defense guidelines, a positive CT would prompt reclassification from mild to moderate TBI [18]. In the vast majority of these patients, CT will be negative for acute traumatic findings, so patients can be safely discharged rather than admitted as long as the neurologic examination is also normal (negative predictive value of 100% for neurologic deterioration requiring surgical intervention) [19]. One analysis quantified the risk of deterioration with both normal CT and neurologic examination as very low (0.006%), recommending discharge regardless of whether there was a responsible adult available to observe the patient [7]. It is important for mild TBI discharge instructions to be provided in written form; they should discuss why or when to return to the ED, plus educational information on postconcussive symptoms [20].
Head Trauma PCAs. MRA Head and Neck There is no relevant literature to support the use of MR angiography (MRA) in the initial imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of functional MRI (fMRI) in the initial imaging evaluation of acute head trauma. MRI Head There is no relevant literature to support the use of MRI in the initial imaging evaluation of acute head trauma (please see Variant 4 for discussion of MRI after negative head CT). MRI Head with DTI There is no relevant literature to support the use of diffusion tensor imaging (DTI) in the initial imaging evaluation of acute head trauma. Radiography Skull There is no relevant literature to support the use of radiographs in the initial imaging evaluation of acute head trauma (replaced by CT, which is more sensitive for neurosurgical lesions). Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the initial imaging evaluation of acute head trauma. Head Trauma military personnel, per Department of Defense guidelines, a positive CT would prompt reclassification from mild to moderate TBI [18]. In the vast majority of these patients, CT will be negative for acute traumatic findings, so patients can be safely discharged rather than admitted as long as the neurologic examination is also normal (negative predictive value of 100% for neurologic deterioration requiring surgical intervention) [19]. One analysis quantified the risk of deterioration with both normal CT and neurologic examination as very low (0.006%), recommending discharge regardless of whether there was a responsible adult available to observe the patient [7]. It is important for mild TBI discharge instructions to be provided in written form; they should discuss why or when to return to the ED, plus educational information on postconcussive symptoms [20].