Head injury: Triage, assessment, investigation and early management of head injury in infants, children and adults
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg56
This is a partial update of NICE clinical guideline 4.
The update has been developed by the National Collaborating Centre for Acute Care using the original scope. The original guideline was also developed by the National Collaborating Centre for Acute Care. In this update, there are new recommendations in the sections on pre-hospital management, emergency department assessment, investigations for clinically important brain injuries, investigation for non-accidental injury in children, and transfer from secondary settings. These are highlighted in the document as 'New'. A number of amendments have been made to other recommendations from the initial guideline, and these are highlighted in the document as 'Amended'.
This guideline addresses assessment, investigation and early management of head injury. This guidance is evidence based and includes the original guideline published in June 2003. This current version is a partial update of the previous guideline. There was sufficient new evidence to prompt an update to be carried out (see section 2 of the full guideline). This update affects only a few recommendations within the original guideline. A summary of the evidence on which the guidance is based is provided in the full guideline produced by the National Collaborating Centre for Acute Care. This guideline replaces the one published in June 2003, and that guideline and associated algorithms are now withdrawn from use.
The guideline offers best practice for the care of all patients who present with a suspected or confirmed traumatic head injury with or without other major trauma. Separate advice is provided for adults and children (including infants) where different practices are indicated. It offers advice on the management of patients with a suspected or confirmed head injury who may be unaware that they have sustained a head injury because of intoxication or other causes. The guideline does not provide advice on the management of patients with other traumatic injury to the head (for example, to the eye or face). It does not address the rehabilitation or long-term care of patients with a head injury but the guideline does explore possible criteria for the early identification of patients who require rehabilitation.
For the purpose of the guideline it was agreed that 'infants' are aged under 1 year, 'children' are 1–15 years old and 'adults' are aged 16 years or older. In certain circumstances, the age group 'infants and young children' (that is, those aged under 5 years) is used. Cut-off points of 10 years and 12 years are also used.
'Head injury' for the purposes of the guideline is defined as any trauma to the head, other than superficial injuries to the face.
The primary patient outcome of concern throughout the guideline is 'clinically important brain or cervical spine injury'. For the purposes of this guideline, clinically important brain or cervical spine injury is defined as any acute condition that has been identified by imaging or by assessment of risk factors.