Managing Head Injury.

December 2018

General Practitioners

Country of origin: UK

The National Institute for Health and Clinical Excellence (NICE) has issued an updated guideline on the early care of adults and children with head injuries. Developed by the National Collaborating Centre for Acute Care, the NICE clinical guideline gives recommendations on the care and treatment options that should be available in the NHS for people with a head injury.

This guideline is a partial update of the original document issued in 2003, revising areas where new evidence has since been published. The guideline also gives some new recommendations, including imaging of children and the need for collaboration between hospitals to achieve optimum care.

Hospital emergency departments see an estimated 750,000 people with head injuries each year. Most head injuries are mild and do not lead to hospital admission, but a small number of people have a moderate or severe injury and may die or go on to have prolonged disability. The advice provided by the guideline includes pre-hospital management, assessment in the emergency department, investigation for clinically important brain and cervical spine injury and indications for specialist referral.

Some recommendations are:

? All patients presenting to an emergency department with a head injury should be assessed by a trained member of staff within 15 minutes of arrival at hospital
? For patients with specified risk factors, computed tomography (CT) imaging of the head should be performed and results analysed within 1 hour of the request having been received by the radiology department
? Children aged under 10 who are in a coma should have CT imaging of the cervical spine within 1 hour of presentation or as soon as they are sufficiently stable
? Where a patient with a head injury requires hospital admission, it is recommended that the patient only be admitted under the care of a team led by a consultant who has been trained in the management of this condition during his/her higher specialist training.

The guidance is available online.

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