Transfer Center


The Queen's Medical Center

Transfer Center
Head Injury Transfer Guidelines


  • Severe Head Injury
    • GCS ≤ 8, unless GCS is 3 with fixed & dilated pupils (may be brain death)  
  • Moderate Head Injury
    • GCS 9 – 12 with clinical risk factors and/or significant CT findings



Clinical Risk Factors

  • CSF Leak
    • Bleeding from ear should not be confused with CSF
  • Penetrating Intracranial Trauma
    • Except GSW with GCS 3 – 4 with injury to both hemispheres or brainstem
  • Focal Neurologic Deficit
    • Abnormal pupil asymmetry
    • New dysconjugate gaze
    • Objective hemiparesis



Significant CT Findings

  • Depressed calvarial skull fracture > 1 cm
  • Basilar skull fracture
  • Midline shift ≥ 4 mm
  • Cerebral contusions
    • Solitary ≥ 10 mm
    • Multiple ≥ 5 mm
  • Subarachnoid hemorrhage ≥ 5 mm
  • Acute subdural hemorrhage
    • SDH > 5 mm in thickness
    • < 5 mm in patients taking anti-platelet or anti-coagulation medications
  • Epidural hemorrhage > 5 mm in thickness
    • EDH in the posterior cranial fossa or in the temporal region are at higher risk for causing brainstem compression


Non-Significant Findings
These findings by themselves do not mandate neurotrauma evaluation or transfer to QMC

  • Isolated non-depressed calvarial skull fractures (whether open or closed)
    • Those involving the posterior table of the frontal sinus or base of the skull may be significant
  • Isolated pneumocephalus
  • Solitary cerebral contusion
    • Measuring < 10 mm in diameter, or multiple contusions measuring < 5 mm in diameter (should be admitted for medical observation & repeat CT in approx. 8 hours, or earlier if neurologic deterioration)
  • Subarachnoid hemorrhage (SAH)
    • Measuring < 5 mm in thickness
    • No specific treatment required
  • Isolated subdural hemorrhage (SDH)
    • Measuring < 5 mm in thickness
    • Should be admitted for medical observation & undergo repeat CT in 8 hours, or earlier if there is neurologic deterioration
  • Isolated epidural hemorrhage (EDH)
    • Measuring < 5 mm in thickness (especially if located in the frontal, occipital or parietal areas)
    • Should be admitted for medical observation & undergo repeat CT in 8 hours, or earlier if there is neurologic deterioration

NOTE:  See complete Head Injury Guidelines for details

03/2008:  ddhokeslj


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