Context

Guidance

Head injuries are a major cause of death and disability in people aged 1 to 40 in the UK. Each year, over 1 million people attend emergency departments in England and Wales with a recent head injury. Between 33% and 50% of these people are aged under 15. About 200,000 people are admitted to hospital with a head injury every year. Of these, about 40,000 have evidence of traumatic brain injury. Most people with a head injury recover without specific or specialist intervention. Others have long-term disability or even die from associated traumatic brain or other injuries. An increasing proportion of people presenting with head injury are over 65. Many people are injured through low-level falls, which can be sustained in the context of acute illness.

The incidence of death from head injuries is low. As few as 0.2% of people attending emergency departments with a head injury die because of their injury. Of people who have sustained a head injury, 95% present with a normal or minimally impaired conscious level, that is, a Glasgow Coma Scale (GCS) score of 13 or more. Most fatal outcomes are in the groups with a moderate (GCS score of 9 to 12) or severe (GCS score of 8 or less) head injury, and account for only 5% of attenders. This means emergency departments need to identify the small number who will go on to have serious acute intracranial complications. It is estimated that, in 25% to 30% of children under 2 who are hospitalised with a head injury, it is caused by abuse. This guideline has updated some of the terminology used in relation to safeguarding people under 18 and vulnerable adults. This update addresses these areas, including in particular:

indications for transporting people with a head injury from the scene of injury directly to the nearest neuroscience centre, bypassing the nearest emergency department
indications for, and timing of, CT head scans and imaging of the cervical spine in the emergency department, with particular reference to anticoagulant treatment and levels of circulating brain injury biomarkers
the clinical and cost effectiveness of administering tranexamic acid to people who have sustained a head injury and have suspected intracranial bleeding
consideration of traumatic injury to the pituitary gland in people with a head injury
information that should be provided to people with a head injury, and their family members and carers, on discharge from the emergency department or observation ward.