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CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF MILD HEAD INJURY (MHI) IN ADULTS

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"last update: 4 Jan 2026"                                                                                                        Download Guideline

- References

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[18]  Diercks DB, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, et al. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Mild Traumatic Brain Injury: Approved by ACEP Board of Directors, February 1, 2023 Clinical Policy Endorsed by the Emergency Nurses Association (April 5, 2023). Ann Emerg Med. 2023;81(5):e63-e105. doi:10.1016/j.annemergmed.2023.01.014

[19]  Shih RY, Burns J, Ajam AA, Broder JS, Chakraborty S, Kendi AT, et al. ACR Appropriateness Criteria® Head Trauma: 2021 Update. Journal of the American College of Radiology. 2021;18(5):S13-S36. doi:10.1016/j.jacr.2021.01.006

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[21]  Ro YS, Shin S Do, Holmes JF, Song KJ, Park JO, Cho JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Acad Emerg Med. 2011;18(6):597-604. doi:10.1111/J.1553-2712.2011.01094.X

[22]  Smits M, Dippel DWJ, De Haan GG, Dekker HM, Vos PE, Kool DR, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519-1525. doi:10.1001/JAMA.294.12.1519

[23]  Jagoda AS, Bazarian JJ, Bruns JJ, Cantrill S V., Gean AD, Howard PK, et al. Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting. Ann Emerg Med. 2008;52(6):714-748. doi:10.1016/j.annemergmed.2008.08.021

[24]  Probst MA, Gupta M, Hendey GW, Rodriguez RM, Winkel G, Loo GT, et al. Prevalence of Intracranial Injury in Adult Patients With Blunt Head Trauma With and Without Anticoagulant or Antiplatelet Use. Ann Emerg Med. 2020;75(3):354-364. doi:10.1016/J.ANNEMERGMED.2019.10.004

[25]  Cipriano A, Pecori A, Bionda AE, Bardini M, Frassi F, Leoli F, et al. Intracranial hemorrhage in anticoagulated patients with mild traumatic brain injury: significant differences between direct oral anticoagulants and vitamin K antagonists. Intern Emerg Med. 2018;13(7):1077-1087. doi:10.1007/S11739-018-1806-1

[26]  Covino M, Manno A, della Pepa GM, Piccioni A, Tullo G, Petrucci M, et al. Delayed intracranial hemorrhage after mild traumatic brain injury in patients on oral anticoagulants: is the juice worth the squeeze? Eur Rev Med Pharmacol Sci. 2021;25(7):3066-3073. doi:10.26355/EURREV_202104_25560

[27]  Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012;59(6). doi:10.1016/j.annemergmed.2012.04.007

[28]  Menditto VG, Lucci M, Polonara S, Pomponio G, Gabrielli A. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med. 2012;59(6):451-455. doi:10.1016/J.ANNEMERGMED.2011.12.003

[29]  Kaen A, Jimenez-Roldan L, Arrese I, Amosa Delgado M, Lopez PG, Alday R, et al. The value of sequential computed tomography scanning in anticoagulated patients suffering from minor head injury. J Trauma. 2010;68(4):895-898. doi:10.1097/TA.0B013E3181B28A76

[30]  Head injury: assessment and early management NICE guideline. Published online 2023. www.nice.org.uk/guidance/ng232. Accessed September 30, 2025