Head Injury CT Criteria Flashcards
According to NICE, who requires a CT head immediately?
- GCS < 13 on initial assessment
- GCS < 15 at 2 hours post-injury
- Suspected open or depressed skull fracture.
- Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
- Post-traumatic seizure.
- Focal neurological deficit.
- More than 1 episode of vomiting
According to NICE Guidelines, who requires a CT head scan within 8 hours of head injury?
- age 65 years or older
- any history of bleeding or clotting disorders
- dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
- more than 30 minutes’ retrograde amnesia of events immediately before the head injury
For Children, what are the NICE criteria for performing a CT scan within 1 hour?
If they have any 1 of the following perform a CT within 1 hour:
- Suspicion of NAI
- Post-traumatic seizure but no history of epilepsy.
- On initial emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15.
- At 2 hours after the injury, GCS less than 15.
- Suspected open or depressed skull fracture or tense fontanelle.
- Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
- Focal neurological deficit.
- For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head.
If they have more than 1 of the following then perform a CT scan:
- Loss of consciousness lasting more than 5 minutes (witnessed).
- Abnormal drowsiness.
- Three or more discrete episodes of vomiting.
- Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 metres, high-speed injury from a projectile or other object).
- Amnesia (antegrade or retrograde) lasting more than 5 minute
What is the minimum amount of time children should be observed for if they only have a risk factor from the more than 1 category?
4 hours minimum.
According to NICE, if someone has a head injury and they are on Warfarin but have no other indicators for a head scan…what should be done?
A CT should be performed in 8 hours of injury.
If a patient represents within 48 hours with worsening symptoms after a head injury, what does NICE suggest you do?
Discuss with a senior clinician to consider if CT scan is appropriate.
