Head injury
CT head guidance: adults
scan within 1 hour for:
- GCS score <= 12 on initial ED assessment
- GCS <15 at 2 hours after the injury on ED assessment
- suspected open or depressed skull fracture
- any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
- post-traumatic seizure
- focal neurological deficit
-
1 episode of vomiting
scan within 8h (or 1h if presenting >8h since injury)
- None of the above
- LOC or amnesia since injury, AND
- age ≥ 65
- bleeding/clotting disorders including liver failure, Haemophilia, anticoagulation/antiplatelets
- dangerous mechanism (RTC, ejected from motor veh, >1m fall)
-
30 min retrograde amnesia immediately before head injury
consider scan if
- No LOC/amnesia AND
- anticoag/antiplatelets (excludes aspirin monotherapy)
CT head NICE guidance: children
scan within 1h for:
- suspicion of non-accidental injury
- post-traumatic seizure without history of epilepsy
- GCS <14 or pGCS <15 on initial assessment
- GCS <15 at 2h after injury
- suspected open/depressed skull fracture, or tense fontanelle
- basal skull fracture
- focal neurological deficit
- for children <1y: bruising/swelling/laceration >5cm
OR none of the above, but more than 1 of:
-
5 min witnessed LOC
- bleeding/clotting disorders
- abnormal drowsiness
-
= 3 episodes vomiting
- dangerous mechanism: RTC, fall >3m, high speed injury from projectile
- amnesia (anterograde/retrograde) >5 min
observe at least 4h after injury if
one risk factor only from above
- scan within 1h if, during observation period:
- GCS <15
- further vomiting
- further abnormal drowsiness
scan within 8h (or within 1h if presenting >8h since injury)
- anticoagulation/antiplatelets (excluding aspirin monotherapy)