Approach to traumatic brain injury (pediatrics) Quiz: Ace Your Exams

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A 15-year-old boy is brought to the emergency department by his coach for evaluation of a closed head injury after being tackled by an opposing player at a football game. The patient’s coach reports that the patient lost consciousness for 1-2 seconds after sustaining a direct blow to the head. The coach says the patient was slurring his words and appeared confused and disoriented after the incident. The patient does not recall the incident, and he now feels dizzy. He has no significant past medical history and does not take any medications. Temperature is 37°C (98.6°F), pulse is 80/min, respirations are 20/min, blood pressure is 122/72 mmHg, and oxygen saturation is 99% on room air. On examination, the patient is well-appearing and in no acute distress. He has an intact neurologic examination aside from a positive Romberg sign. Fundoscopic examination is within normal limits. Which of the following is the next best step in management?

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Magnetic resonance imaging (MRI) of the brain with and without contrast

Lumbar puncture

Admission for serial neurologic examinations

Monitoring followed by concussion discharge instructions

Computed tomography (CT) of the brain without contrast