When to Refer to Emergency Department

Players who have suffered a head impact should immediately be referred to the emergency department of a hospital if they have:

  • been unconscious for more than two minutes
  • exhibit focal neurological signs such as weakness, altered sensation or reflexes
  • any deterioration in their level of consciousness
  • a seizure
  • a worsening headache
  • repeated vomiting if over 12 years of age, or even a single episode if younger
  • Higher risk athletes or those with co-morbidities
  • athlete received inadequate supervision following the injury

In these cases it is important to rule out intracranial bleeding or swelling using MRI or CT scanner.

General guidelines

  • LOC greater than 2 minutes
  • Focal neurological findings
  • Worsening mental status
  • Seizure activity
  • Worsening headache
  • Single emesis for player <12 years of age
  • Repeated emesis for older players

Concern is for structural injury requiring radiological assessment (MRI or CT) scan

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