In children ≥2 years, high-risk clinical features include altered mental status, focal neurologic deficits, signs of a skull fracture, or seizures Children with any of these features should be referred for emergent imaging Additional findings concerning for increased risk of ICI include LOC, persistent vomiting, persistent/progressive or severe headache, or severe mechanism of injury In children with one of these features (or two mild features), observation (versus emergent imaging) may be considered based on the clinical scenario, provider experience, and parental preference If observation is initiated, the child should be observed for to hours for any signs of clinical deterioration, which would include neurologic abnormalities, mental status depression, persistent vomiting, or increasingly severe headache A CT scan should be obtained if these signs or symptoms develop As previously stated, discrete abnormalities may be identified on CT scan, but if the scan is normal, then the child has suffered a concussion or extracranial injury It is important to note that symptomatic children without evidence of TBI on CT scan may still suffer from persistent and/or debilitating symptoms that require admission or close outpatient follow-up