NBT
- Significant head injury as main presenting complaint and/or high clinical suspicion of intracranial haemorrhage and/or patient would not need admission if CTH ok -> ED. Call to ED to pre-alert.
- More vague presentation/history of head injury but as part of a more general decline/likely to require admission under medicine anyway/ unlikely to be a good candidate for urgent neurosurgery – ok to come straight to Medicine (31ASS/32A).
For advice, please consider discussing with ED or Acute Medicine Consultant.
Patients with head injury as their main concern (who require a rule out CT Head) are not suitable for AEC.
BRI/WGH
If main concern is ?SDH then please direct to ED. Please call ahead to ED (numbers on the telephone directory.
CKS head injury guidance
Please see the following guidance from CKS about who may need a CT head:
- Refer an adult or child immediately to the hospital emergency department, accompanied by a competent adult, if there are any of the following risk factors, which may indicate an intracranial complication or cervical spine injury:
- A Glasgow Coma Scale (GCS) score of less than 15 on initial assessment.
- Evidence of shock, or other injuries suggesting chest or abdominal trauma, limb or pelvic trauma, or significant vascular injury.
- Dangerous mechanism of injury or high-energy head injury.
- A history of bleeding or coagulation disorders, or current anticoagulant medication.
- Current alcohol or drug intoxication.
- Any loss of consciousness after the injury (even if they are fully alert on presentation).
- Any post-traumatic seizure.
- Any previous brain surgery.
- Amnesia (antegrade or retrograde) lasting more than 5 minutes. Note: assessment of amnesia is unlikely to be possible in a child aged under 5 years.
- Persistent headache since the injury.
- Vomiting since the injury — particularly more than one episode in an adult or three or more episodes in a child, using clinical judgement.
- Any focal neurological deficit since the injury.
- A suspected open or depressed skull fracture, or tense fontanelle in a child.
- A suspected basal skull fracture.
- Signs of a penetrating injury or visible trauma to the scalp or skull — in children under 1 year of age, a bruise, swelling, or laceration of more than 5 cm on the head.
- Suspected cervical spine injury following assessment of the neck.
- Concern about the diagnosis of head injury.
- Note: if there is any suspicion of cervical spine injury, full cervical spine immobilization should be arranged before transfer to hospital.
- Refer an adult or child immediately to the hospital emergency department, accompanied by a competent adult, if there is:
- Possible non-accidental injury, safeguarding concerns, or a vulnerable person is affected.
- Consider referral of an adult or child to the hospital emergency department, accompanied by a competent adult, if there are any of the following risk factors, depending on clinical judgement:
- Irritability or altered behaviour, particularly in infants and children aged under 5 years.
- Other visible trauma to the scalp or skull.
- A responsible adult is unable to stay with the person for the first 24 hours after the injury.
- Ongoing concern by the person or their family/carers.
- For all other children and adults who are at low risk of an intracranial complication or cervical spine injury:
- Advise that a responsible adult should stay with the person for the first 24 hours after the injury.
- Give the person and/or family/carers verbal and written information and self-care advice.