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Approximately 1.4 million people a year attend emergency departments (EDs) in England and Wales with a recent head injury. Between one-third and a half of these are children aged under 15 years.1 A large majority of these present with a normal or minimally impaired conscious level; in Australia and New Zealand, 98.3% of children presenting to EDs with a head injury have a Glasgow Coma Scale (GCS) score of 14 or 15 on initial assessment.2 Many of these children can be safely discharged, but a small minority may have intracranial injury, skull fracture or other significant injuries. Twenty of every 1000 children (2%) presenting to EDs in Australia and New Zealand with head injuries of all severities had an abnormal CT head scan.
In the UK, the National Institute for Health and Care Excellence Clinical Guideline 176 (NICE CG176)1 makes recommendations about which children should have radiological investigation. This guideline was published in 2014 and updated in 2019. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) guideline for mild to moderate head injuries in children (the PREDICT guideline) (box 1), published in 2021, covers diagnosis and acute management of children with mild to moderate head injury (box 2) who present to hospital within 72 hours of injury. This is the first such national consensus guideline for paediatric head injury in Australia and New Zealand. It covers triage, decision-making regarding imaging or structured observation, discharge criteria and information, and follow-up. Unlike NICE CG176, it does not cover cervical spine imaging.
Full guideline (https://www.predict.org.au/download/predict-head-injury-guidelines/PREDICT-Head-Injury-Guideline-_Full-guideline-V1-29.1.21-.pdf).
Guideline summary (https://www.predict.org.au/download/predict-head-injury-guidelines/PREDICT-Head-Injury-Guideline_-Summary-V1-29.1.21-.pdf).
Definition of mild to moderate head injury2
Glasgow Coma Scale (GCS) score of 14 or 15 on initial clinician assessment.
GCS of 13 or less with normal head CT scan and returning to normal baseline neurological function within a few hours.
Evidence and basis for recommendations
In 2017, PREDICT assessed …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.