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Practice Guidelines

Early management of head injury: summary of updated NICE guidance

BMJ 2014; 348 doi: (Published 22 January 2014) Cite this as: BMJ 2014;348:g104

This article has a correction. Please see:

  1. Sarah Hodgkinson, senior research fellow and project manager1,
  2. Vicki Pollit, senior health economist1,
  3. Carlos Sharpin, joint head of information science/research fellow1,
  4. Fiona Lecky, clinical professor, honorary professor, honorary consultant in emergency medicine2
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2EMRiS, Health Services Research, School of Health and Related Research, University of Sheffield/University of Manchester/Salford Royal Hospitals NHS Foundation Trust, Sheffield S1 4DA, UK
  1. Correspondence to: Fiona Lecky fiona.lecky{at}

Head injury is the commonest cause of death and disability in people aged 1-40 years in the UK. Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury. The National Institute for Health and Care Excellence (NICE) published guidance on managing head injury in 2003 (clinical guideline 4)1 and updated this in 2007 (clinical guideline 56),2 which resulted in computed tomography (CT) replacing skull radiography as the primary imaging modality for assessing head injury. Key changes driving this update include the introduction of regional trauma networks with prehospital major trauma triage in England; the extension of indications for anticoagulation therapy; the establishment of local safeguarding boards in the UK, requiring front-line clinical staff to assess not only the severity of the head injury but also why it occurred; and new evidence on the initial assessment and early management of head injury.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).3


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Transport to hospital

  • Transport patients who have sustained a head injury directly to a hospital that has the resources to further resuscitate them and to investigate and initially manage multiple injuries.

    • - All acute hospitals receiving patients with head injury directly from an incident should have these resources, which should be appropriate for a patient’s age

    • - In NHS England these hospitals would be trauma units or major trauma centres. In NHS Wales this should be a hospital with equivalent capabilities

    • (New recommendation.) [Based …

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