The two extremes of the continuum between “simple head injury” and “potential/actual brain injury”1-150
| Simple head injury | Brain injury |
| Benign mechanism1-150 (wearing protection) | Violent mechanism (no protection) |
| Consciousness/recall retained throughout; no amnesia | Loss of consciousness > 5 min |
| Vomiting less than twice (see text) | Persistent vomiting |
| Transient headache (responds to simple analgesia) | Persistent headache |
| Superficial bruising or laceration; latter < 5 cm long | Boggy swelling, excess scalp tenderness, or more extensive laceration; signs of basal skull fracture |
| Neurological signs absent | Focal neurological signs |
| Child protection concerns not present | Possible abuse (see comment in text) |
| Babies | Full anterior fontanelle |
| Clinical features clear | Features vague |
| Fall < 60 cm or to non-hard surface | Fall from > 60 cm, etc |
| Action | Action |
| Discharge with age appropriate head injury advice to care of responsible adult with ready access to hospital | Observe closely, liaise with neurosurgeons; if shows signs of deterioration, CT early |
The further towards the right hand column the clinical features are, the greater the risk of intracranial injury, and of the need for urgent CT scanning.
↵1-150 Modified from Report of a Working Party on the Management of Head Injuries.20