Head injury is a significant economic, social and medical problem all over the world. For this reason, prognostic factors in head injury are of major importance to all surgeons who treat severely injured patients. Outcome of severe head injury is frequently determined at the time of impact, and surgical and medical treatment is often ineffective. Often patients with traumatic brain injury (TBI) initially presenting to non-tertiary care facilities required interhospital transfer for neurosurgical and intensive care services. Delays in initiating definitive neurosurgical care in regions with long ground travel times are common. Despite the potential seriousness of traumatic brain injury, not all individuals who sustain a severe brain injury will benefits interhospital transfer for specialized care and resources. Relying exclusively upon the severity of the Glasgow Coma Scale as a criteria to identify patients for interhospital transfer for CT scanning and high level of care may not be ideal, as not all severely brain injured patient will benefits form the transfer. In many circumstances, the decision to transfer must balance the costs, risks, prognosis, and resources required for transport with the procedures and treatments that will be provided when he/she arrives at the tertiary care facility. We reason that there is a need to develop clinical decision driven guidelines, using information readily available during the initial emergency department evaluation, to identify those group of severely brain injured patients that are not likely to benefits from the transfer.