Synopsis
Identify intracranial and cervical injury promptly, apply current NICE CT criteria and timing, prevent secondary brain injury, and discharge only with reliable supervision and safety-net advice.
- Record GCS eye, verbal and motor components, pupils, focal neurology, amnesia, loss of consciousness, vomiting, seizure, mechanism, alcohol or drugs, anticoagulants and time since injury.
- Stabilise airway, oxygenation and circulation with cervical protection before imaging; one episode of hypotension or hypoxaemia can worsen neurological outcome.
- Adults need CT head within 1 hour for GCS 12 or less initially, GCS below 15 at 2 hours, suspected open or depressed fracture, basal-skull sign, post-traumatic seizure, focal deficit or more than one vomiting episode.
Key red flags
GCS below 15 at 2 hours, suspected open or depressed fracture, basal-skull signs, post-traumatic seizure, focal neurological deficit or more than one vomiting episode triggers adult CT within 1 hour under NICE criteria.
Investigation priorities
Identify haemorrhage, fracture, mass effect and surgical lesions within NICE timing.
Management branches
Any patient presents after head trauma with symptoms, altered consciousness or concerning mechanism.
- Run ABCDE with cervical protection, correct hypoxia, hypotension and glucose, control bleeding and call anaesthetic help for an unprotected airway.
- Record GCS components, pupils, focal neurology, fracture signs, vomiting, seizure, amnesia, mechanism, medicines and time from injury.
Key medicines
Paracetamol for uncomplicated head-injury painGive 1 g orally up to four times daily when required, at least 4 hours apart, with a maximum of 4 g in 24 hours; use a lower maximum for low body weight, frailty, malnutrition or liver risk.