Management of Minor Brain Injury (GCS Score 13 – 15) from the ATLS Course

“Minor traumatic brain injury (MTBI) is defined by a history of disorientation, amnesia, or transient loss of consciousness in a patient who is conscious and talking. This correlates GCS score between 13 and 15.”*

“Most patients with minor brain injury make uneventful recoveries. Approximately 3% have unexpected deterioration, potentially resulting in severe neurologic dysfunction unless the decline in mental status is detected early.”*

Head CT is required for patients with minor head injuries (i.e., witnessed loss of consciousness, definitive amnesia, or witnessed disorientation in a patient with GCS score of 13—15) and any one of the following factors:
High risk for neurosurgical intervention

  • GCS score less than 15 2 hours after injury
  • Suspected open or depressed skull fracture
  • Any sign of basilar skull fracture (e.g., hemotympanium, raccoon eyes, CSF otorrhea, Battle’s sign)
  • Vomiting (more than two episodes)
  • Age more than 65 years
Moderate risk for brain injury on CT

  • Loss of consciousness (more than 5 minutes)
  • Amnesia before impact (more than 30 minutes)
  • Dangerous mechanism (e.g., pedestrian stuck by motor vehicle, occupant ejected from motor vvehicle, fall from more than3 feet or five stairs)

The table is adapted from The Canadian CT Head Rule for patients with minor head injury. Lancet 2001;357; 1294.

“Applying these [the above] parameters to patients with a score of 13, approximately 25% will have a CT finding indicative of trauma, and 1.3% will require neurosurgical intervention. Applying this to patients with a GCS score of 15, 10% will have CT findings indicative of trauma, and 0.5% require neurosurgical intervention”*

“If abnormalities are observed on the CT scan, or if the patient remains symptomatic or continues to have neurologic abnormalities, he or she should be admitted to the hospital , and a neurosurgeon should be consulted.”*

*Advanced Trauma Life Support Student Course Manual,9th ed, 2012, American College of Surgeons, p. 158.



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