[An abnormal CT scan following a mild traumatic brain injury; what then?]

CT scan reveals traumatic intracranial abnormalities in fewer than 10% of patients following mild traumatic brain injury (mTBI). Management policy in these patients is not clear. Clinical or radiological deterioration occurs in 10-20% of this risk group, usually within 24 hours and often without neurosurgical consequences. Patients with mTBI and subarachnoid blood or small foci of contusion do not need to be admitted to medium/high care or to the ICU. This is warranted in patients fulfilling the following criteria: age > 65 years; a Glasgow Coma Scale (GCS) score < 15; anticoagulant use; or multiple trauma. It is also warranted by fulfilment of one or more of the following CT-criteria: shift of the midline; subdural or epidural haematoma; a temporal or subfrontal focus of contusion; or intraparenchymatous bleeding > 10 ml. Repeated CT-scan is only indicated in case of clinical deterioration. Transfer to a neurosurgical centre is not necessary in the majority of patients with mTBI and CT abnormalities.