Head injury: assessment & imaging
Introduction
Head injury is a common emergency presentation, ranging from minor scalp wounds and concussion to life‑threatening intracranial haemorrhage. Early, guideline‑directed assessment and timely CT imaging are central to identifying injuries that need neurosurgical or critical care intervention.
In the UK, the NICE guideline NG232 (2023) is the primary decision framework for imaging adults and children; local ED protocols should operationalise NG232 and reference RCEM practical guidance for anticoagulated patients and local radiology diagnostic reference levels (NDRLs) for CT justification and dose‑optimization (NICE NG232; RCEM; GOV.UK).
Initial assessment (priorities)
Follow standard trauma priorities: airway (with cervical‑spine control where indicated), breathing, circulation, disability (neurological status) and exposure (ABCDE).
Key immediate actions
- Rapid primary survey and resuscitation; protect the airway if GCS ≤ 8 or there is airway compromise.
- Record GCS and pupillary responses; document limb power and any focal signs.
- Identify mechanisms that transfer high energy to the head (falls from height, high‑speed RTC, ejection) and any penetrating injury.
- Obtain concise history where possible: loss of consciousness (duration), amnesia, seizure, vomiting, bleeding disorders, anticoagulant/antiplatelet use, alcohol/drug intoxication, prior neurosurgery.
- Stabilise, resuscitate and protect the airway before transfer or imaging.