NICE guidance on investigation

NICE has strict and clear guidance regarding which adult patients are safe to discharge and which need further CT head imaging. The latter group are also divided into two further cohorts, those who require an immediate CT head and those requiring CT head within 8 hours of injury:

CT head within 1 hour

• GCS < 13 on initial assessment
• GCS < 15 at 2 hours post-injury
• 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.
• more than 1 episode of vomiting

CT head scan within 8 hours of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:

• age 65 years or older
• any history of bleeding or clotting disorders including anticogulants
• dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
• more than 30 minutes' retrograde amnesia of events immediately before the head injury

If a patient is on warfarin who have sustained a head injury with no other indications for a CT head scan, perform a CT head scan within 8 hours of the injury.