Practice Guidelines

Assessment, investigation, and early management of head injury: summary of NICE guidance

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39331.702951.47 (Published 04 October 2007) Cite this as: BMJ 2007;335:719
  1. David Yates, chairman1,
  2. Rifna Aktar, project manager2,
  3. Jennifer Hill, director2
  4. Guideline Development Group
  1. 1Trauma Audit and Research Network (TARN), Manchester M6 8HD
  2. 2National Collaborating Centre for Acute Care (NCC-AC), Royal College of Surgeons of England, London WC2A 3PE
  1. Correspondence to: J Hill NCC-AC{at}rcseng.ac.uk

    Why read this?

    Head injury is a major public health problem both logistically and clinically. Many patients seek healthcare advice for this, although relatively few will need care in a neuroscience centre. Most will make a good recovery, but the incidence of ensuing disability even after apparently “minor” injury is surprisingly high.

    This article summarises the most recent guidance update from the National Institute for Health and Clinical Excellence (NICE) on the appropriate investigation and early care of patients with head injury, where there has been a significant shift from “admit and observe” to “diagnose and decide.”1

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

    CT imaging of the head in adults

    Request computed tomography (CT) brain scan immediately for adult patients with any of the following risk factors:

    • Glasgow coma score <13 on initial assessment in the emergency department

    • Glasgow coma score <15 two hours after the injury on assessment in the emergency department

    • Suspected open or depressed skull fracture

    • Any sign of basal skull fracture

    • Post-traumatic seizure

    • Focal neurological deficit

    • One or more episodes of vomiting

    • Amnesia for events more than 30 minutes before impact.

    CT imaging of the head in children

    Request computed tomography of the brain immediately for children with any one of the following risk factors:

    • Age over 1 year: Glasgow coma score <14 on assessment in the emergency department

    • Age under 1 year: Glasgow coma score paediatric <15 on assessment in the emergency department

    • Age under 1 year and presence of bruise, swelling, or laceration (>5 cm) on the head

    • Dangerous mechanism of injury

    • Clinical suspicion of non-accidental injury

    • Loss of consciousness lasting more than five minutes (witnessed)

    • Post-traumatic seizure but no history of epilepsy

    • Abnormal drowsiness …

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