Blunt head injury with which findings triggers transport?

• A. Suspected skull fracture, GCS ≤ 14, seizures, unequal pupils, or focal neurological deficit
• B. Normal exam and GCS 15
• C. Contusion without symptoms
• D. Isolated headache only

Answer: (A)

When blunt head injury shows signs that suggest a higher risk of intracranial injury, transport to a higher level of care is triggered. The findings listed—suspected skull fracture, a Glasgow Coma Scale score of 14 or less, seizures, unequal pupils, or a focal neurological deficit—flag potential brain injury or evolving deterioration and warrant ED evaluation and imaging.

Each element adds concern: a suspected skull fracture raises the possibility of underlying brain injury or bleeding; a GCS of 14 or lower indicates reduced level of consciousness and potential worsening; seizures can signal cortical irritation from injury; unequal pupils may reflect rising intracranial pressure or brain herniation risk; focal neurological deficits point to localized brain injury. Because head injuries can worsen over time, these signs push for prompt transport.

In contrast, a normal exam with a perfect GCS, contusion without symptoms, or an isolated headache alone are not by themselves reliable triggers for transport under this policy, since they indicate a lower immediate risk and may be managed with observation if no other red flags are present.