TABLE 41.3 CRITERIA FOR DISCHARGE WITH HOME OBSERVATION Traumatic force not life threatening Glasgow Coma Scale score of 15 Nonfocal neurologic examination No significant symptoms No history of prolonged loss of consciousness (or normal CT if it did occur) No intracranial abnormalities on CT (if obtained) Reliable caregivers who are able to return, if necessary No suspicion of abuse or neglect CT, computed tomography Most children presenting to the ED after blunt head trauma will not require advanced imaging or observation These remaining children, who sustained impact of minor force, had no LOC, and are alert and asymptomatic with normal examinations, likely have only minor head trauma with or without extracranial injuries, including contusions and lacerations Home observation is appropriate management for the majority of these patients Rarely, intracranial complications develop in these children, causing symptoms hours after the traumatic event; therefore, the caregiver should be given a printed list of signs and symptoms (reviewed verbally by the clinician) indicative of increased ICP with instructions to check the child at regular intervals and to return to the ED if symptoms occur Postconcussive counseling (especially with regard to return to sports), when indicated, should also be given The caregivers must be reliable and able to return with the child if necessary, and there must be no suspicion of abuse or neglect— otherwise admission for observation in the hospital should be considered ( Table 41.3 ) Suggested Readings and Key References Babl FE, Borland ML, Kochar A, et al Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study Lancet 2017;389:2393–2402 Badawy MK, Dayan PS, Tunik MG, et al Prevalence of brain injuries and recurrence of seizures in children with posttraumatic seizures Acad Emerg Med 2017;24(5):595–605