Always On EM - Mayo Clinic Emergency Medicine GRAND ROUNDS - Dr. Neha Raukar - Head's Up! When is that lump more than a bump?
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Dec 1, 2025 
Dr. Neha Raukar, associate professor and dual board-certified expert in emergency and sports medicine, renowned for concussion and TBI care. She reviews who needs imaging and CT decision rules. She breaks down rapid ED concussion exams like balance and ocular tests. She covers counseling, activity guidance, biomarkers on the horizon, and prevention strategies in sports-related head injury.
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Use The Right Head CT Rule For Each Patient
- Use validated CT decision rules to decide imaging rather than scanning everyone with head trauma.
- Know the New Orleans versus Canadian differences (headache/vomiting thresholds, age cutoffs, intoxication, basilar skull signs) and apply the appropriate rule for your patient population.
Record An ED Symptom Score For Follow Up
- Document an ED symptom score (SCAT/PCSS) to create a baseline for outpatient tracking and referrals.
- Hand patients the CDC Heads Up symptom checklist and note the ED score to improve continuity with primary care or concussion clinics.
Diagnose Concussion With A One Minute Functional Exam
- Screen for concussion in the ED with a quick balance and vision exam rather than relying only on CT.
- Do the three 20-second balance positions and a one-minute visual exam (smooth pursuit, saccades, convergence) to detect functional signs.