Update information

Update information

September 2019: Recommendation 1.4.12 on when to have a CT scan was updated to change warfarin to anticoagulants.

June 2017: Recommendations 1.2.8 and 1.4.12 were updated with cross-references to related NICE guidelines. An outdated research recommendation was stood down and removed.

January 2014

Recommendations marked [new 2014] indicate that the evidence has been reviewed and the recommendation has been added or updated.

Recommendations marked [2007, amended 2014], [2003, amended 2014],and [2003, amended 2007 and 2014] last had an evidence review in 2007 and 2003 respectively.

Changes have been made to the recommendation wording in line with current practice and equality considerations as outlined below:

  • Recommendation 1.6.1: We removed the reference to the provision of a staff photographic board. The GDG considered this to be a safety/security risk for staff in some departments.

  • Recommendation 1.1.2: we updated NHS Direct to NHS 111.

  • Recommendation 1.1.3: we updated NHS Direct to NHS 111. We also removed 'age 65 years or older' as a factor for referring to the emergency department' as an equality consideration.

  • Recommendation 1.1.4: removed 'age 65 years or older' as a factor for referring to the emergency department' as an equality consideration. We also added an extra bullet point to highlight safeguarding concerns (widely used terminology).

  • Recommendation 1.1.5: removed 'adverse social factors' when observing the injured person at home, as the committee considered this as inappropriate terminology.

  • Recommendation 1.2.16: replaced the term 'non-accidental injury' with safeguarding as non-accidental injury is a child specific term and therefore appears to exclude adults. Text has been added to indicate that information should be documented

  • Recommendation 1.2.12: 'analgesia as described in 1.4.1.9 should be given only under the direction of a doctor' removed, as this is covered in the first sentence. The committee felt that this needs to be managed under local protocols. It covers additional complexities which have not been reviewed and may be confusing to readers.

  • Recommendation 1.5.2: first sentence removed as this is now unnecessary. Imaging practice has moved on: with modern multislice scanners the whole cervical spine can be scanned at high resolution with ease and multiplanar reformatted images generated rapidly.

  • Recommendation 1.5.3: changes based on updated terminology and current practice.

  • Recommendation 1.5.14: amended based on committee consensus as satisfactory peg views can often be obtained in those younger than 10 (essentially down to the age where they can obey the command to open their mouth nice and wide – usually about 5 years of age).

  • Recommendation 1.3.11: updated to reflect current terminology and equality consideration. This guideline did not previously include a recommendation for safeguarding concerns in adults ('A clinician with expertise in non-accidental injuries in children should be involved in any suspected case of non-accidental injury in a child'). Text also added to indicate that information should be documented.

  • Recommendation 1.3.13: reference to neurosurgical letter removed to reflect current practice.

  • Recommendation 1.7.5: reference to portable phone deleted, as this is outdated terminology. Additional text added for clarity: 'changes in the patient's status'

  • Recommendations 1.7.12 and 1.7.17: updated based on equality consideration to allow patient discussion.

[2003, amended 2007] indicates that the evidence has not been reviewed since 2003 but minor changes were made in 2007 for clarification.

Recommendations marked [2003] and [2007] last had an evidence review in that year.

Minor updates since publication

October 2019: A section heading was amended to match with the change made to recommendation 1.4.12 in September 2019. Recommendations 1.1.3 and 1.1.4 have been amended to remove warfarin as an example of an anticoagulant so it's clear it applies to all anticoagulants.

ISBN: 978-1-4731-0405-1

  • National Institute for Health and Care Excellence (NICE)