In the United Kingdom some 500 000 children attend accident and emergency departments after a head injury and about 50 000 are admitted (nearly 10% of all hospital admissions). The death rate is 5.3 per 100 000 children.1 Despite various guidelines on the management of head injury, clinical practice varies. Two papers in this week's BMJ shed new light on the management of mild head injury in children admitted to emergency departments.²³ They compare immediate computed tomography for triage with inpatient observation in mild head injury—920 of the 2602 enrolled patients were aged 6-15. No child died or needed surgical intervention. Early discharge after immediate computed tomography was no worse in terms of recovery at three months, later complications, and patient satisfaction; it was also less costly than inpatient observation.

Here is a scenario familiar to emergency department doctors, paediatricians, and general practitioners. A child suffers apparently mild head trauma with brief loss of consciousness. When seen, he or she has normal neurological findings and …