A subset of MACE 2 red flags suggest high risk of brain injury with intracranial hemorrhage. If any one of the following red flag signs or symptoms are present, the casualty should be referred urgently for CT scan.

Do not delay evacuation to obtain TBI whole blood biomarkers.

In addition, casualties with evidence suspicious for a penetrating brain injury, depressed skull fracture, or signs of a basilar skull fracture (e.g., raccoon eyes, Battle’s sign, otorrhea) should be referred urgently for CT scan.