Are there any guidelines regarding when to send a patient with a traumatic brain injury for neurometric testing? Is loss of consciousness no longer a must for a concussion diagnosis? —DALE BERGESON, PA-C, Colfax, Wis.

Brain concussion is a diffuse head injury usually associated with a transient loss of consciousness lasting only seconds to minutes. Prediction models built on clinical variables are able to identify most patients with clinically important intracranial lesions but fail to achieve 100% sensitivity. Therefore, head CT scan is recommended for all patients who lose consciousness. Other indications for CT scan after traumatic brain injury include nausea or vomiting, posttraumatic seizure, amnesia, continued headache, history of coagulopathy, intoxication without improvement after observation, focal neurologic deficit, mental status deficit, and skull fracture.—JoAnn Deasy, PA-C, MPH (143-7)

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