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Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176)
  1. Tessa Davis,
  2. Anna Ings
  1. Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Tessa Davis, Sydney Children's Hospital, Sydney, New South Wales 2030, Australia; tessardavis{at}me.com

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Key issues

Very few children and young people who present with head injury will have significant intracranial pathology. This presents a common diagnostic dilemma for physicians, as these injuries need to be rapidly identified.1 The previous National Institute of Health and Care Excellence (NICE) head injury guidelines published in 2003 and updated in 2007, established CT scan as the primary imaging modality in head injury.

CT provides rapid, definite diagnosis of intracranial injuries, and guides subsequent neurosurgical management, but is associated with significant risks and costs.2 ,3 This NICE update is necessary to ensure the best evidence-based practice regarding initial assessment of head injury and ensuring rapid imaging where appropriate.

This NICE guideline also updates some terminology regarding safeguarding children, as the injuries of up to 30% of children aged under 2 years admitted with head injury will be the result of non-accidental/abusive injury.4

As well as reviewing indications and timing of CT brain in the emergency department (ED), this update also addresses indications for transporting head-injured patients directly from the scene to the nearest neuroscience centre, and information that should be given on discharge of head-injured patients.

Although this guideline includes adults, for the purposes of review, this paper will focus on children and young people.

What should I stop doing?

  • Waiting a long time for radiology reports. The new guidance sets the standard for radiologists to produce a provisional written report within an hour.

  • Stop describing the Glasgow Coma Scale (GCS) as one number. Ideally this should be in three sections (e.g. E3, V4 and M4) but if it is a total, then give it a denominator to avoid confusion (e.g. 12/15).

What should I start doing?

  • Give age-appropriate verbal and printed discharge advice on managing …

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