NICE guidelines for CT scanning of high risk patients
| Patients who have sustained a head injury and present with any one of the following risk factors should have CT scanning of the head immediately requested: |
| • GCS less than 13 at any point since the injury |
| • GCS equal to 13 or 14 at 2 hours after the injury |
| • Suspected open or depressed skull fracture |
| • Any sign of basal skull fracture (haemotympanum, “panda” eyes, cerebrospinal fluid otorrhoea, Battle’s sign) |
| • Post-traumatic seizure |
| • Focal neurological deficit |
| • More than one episode of vomiting (clinical judgement should be used regarding the cause of vomiting in those aged 12 years or younger, and whether imaging is necessary) |
| • Amnesia for greater than 30 minutes of events before impact. The assessment of amnesia will not be possible in pre-verbal children and is unlikely to be possible in any child aged under 5 years |
| CT should also be immediately requested in patients with any of the following risk factors, provided they have experienced some loss of consciousness or amnesia since the injury: |
| • Age greater than or equal to 65 years |
| • Coagulopathy (history of bleeding, clotting disorder, current treatment with warfarin) |
| • Dangerous mechanism of injury (a pedestrian struck by a motor vehicle, an occupant ejected from a motor vehicle, or a fall from a height of greater than 1 metre or five stairs). A lower threshold for height of falls should be used when dealing with infants and young children (that is, aged under 5 years) |