Head injury safety-net workflow

Scope

Use for

Initial adult outpatient/urgent-care triage for minor head injury and concussion; pediatric assessment uses a separate pathway.

Not for

• Major trauma, unstable vitals, or active emergency resuscitation scenarios.
• Inpatient neurotrauma management protocols.

Immediate actions

• Document injury time/mechanism, loss of consciousness, amnesia, vomiting, Glasgow Coma Scale, pupils, and neurologic findings; assess associated cervical injury.
• Check anticoagulants/antiplatelets, bleeding disorders, intoxication, and available home supervision before choosing disposition.

Red flags: escalate now

If any of these are present, stop routine steps and follow the urgency stated. Activate emergency care for instability or findings that need immediate transfer.

• Emergency transfer is needed for declining consciousness, seizure, focal deficit, repeated vomiting, skull-fracture signs, severe worsening headache, or suspected significant cervical injury.
• Anticoagulation/bleeding disorders require urgent imaging assessment; a negative decision rule must not be used to clear patients outside its validated population.

First-line plan

• Assess need for CT with the Canadian CT Head Rule only after checking all inclusion/exclusion criteria; do not use it to clear anticoagulated patients. NEXUS addresses the neck, not head CT.
• Home observation requires normal mental status, improving symptoms, no unresolved imaging indication, and a responsible support person who understands written deterioration instructions.
• Use relative rest for 24–48 hours, then progressively resume light cognitive/physical activity as tolerated. Avoid prolonged strict rest and activities risking another head injury; no same-day return to sport.

Follow-up and monitoring

• Arrange follow-up within 1–2 weeks; review symptoms, function, and a graded return to work/activity. Refer for persistent or atypical symptoms.
• Do not drive while symptoms impair safe driving; give the patient and support person clear emergency instructions for deterioration.

Before the patient leaves

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

• Point to the red flags above that apply to this patient.
• Confirm follow-up timing and where to go after hours.
• Attach a relevant handout to reinforce the plan.
• Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

About this workflow

Clinical owner

Family Medicine Editorial Team

Risk tier

High

Review cadence

Every 3 months

Last reviewed

September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Review status

Evidence current. Next review due December 4, 2026.

References

• Living Concussion Guidelines Diagnosis and imaging (opens in a new tab)
• Living Concussion Guidelines Initial management (opens in a new tab)