| Computed tomography of the head is required if any of the following criteria are present. |
| History |
- Witnessed loss of consciousness of >5 min duration
- History of amnesia (either antegrade or retrograde) of >5 min duration
- Abnormal drowsiness (defined as drowsiness in excess of that expected by the examining doctor)
- ≥3 vomits after head injury (a vomit is defined as a single discrete episode of vomiting)
- Suspicion of non-accidental injury (NAI, defined as any suspicion of NAI by the examining doctor)
- Seizure after head injury in a patient who has no history of epilepsy
|
| Examination |
- Glasgow Coma Score (GCS) <14, or GCS <15 if <1 year old
- Suspicion of penetrating or depressed skull injury or tense fontanelle
- Signs of a basal skull fracture (defined as evidence of blood or cerebrospinal fluid from ear or nose, panda eyes, Battles sign, haemotympanum, facial crepitus or serious facial injury)
- Positive focal neurology (defined as any focal neurology, including motor, sensory, coordination or reflex abnormality)
- Presence of bruise, swelling or laceration >5 cm if <1 year old
|
| Mechanism |
- High-speed road traffic accident either as pedestrian, cyclist or occupant (defined as accident with speed >40 m/h)
- Fall of >3 m in height
- High-speed injury from a projectile or an object
|
| If none of the above variables are present, the patient is at low risk of intracranial pathology. |
