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Am Fam Physician. 2024;109(5):480-481

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• The Canadian CT Head Injury/Trauma Rule is the most accurate clinical decision tool and should be used to determine the need for imaging after a head injury.

• Patients taking anticoagulants require immediate imaging after mild TBI. Observation and repeat imaging are not recommended if initial imaging and neurologic examination are normal.

• Patients at high risk for postconcussive syndrome may benefit from more physical and cognitive limitations and referral for early intervention. 

From the AFP Editors

Traumatic brain injuries (TBIs) can be caused by an external force to the head or body or a penetrating injury to the head. These injuries can result in changes in cognition, sensation, language, or emotion. In mild TBI, patients have loss of consciousness for 30 minutes or less, a Glasgow Coma Scale score of 13 to 15 at least 30 minutes after injury, and transient neurologic abnormalities such as posttraumatic amnesia, focal symptoms or signs, or seizure for 24 hours or less. Up to 15% of patients with mild TBI will have evidence of intracranial injury on imaging, with 1% requiring neurosurgical intervention. The American College of Emergency Physicians (ACEP) has published new guidelines for evaluation of mild TBI.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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