Table 1

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 amnesiaLoss 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 longBoggy swelling, excess scalp tenderness,   or more extensive laceration; signs of basal skull fracture
Neurological signs absentFocal neurological signs
Child protection concerns not presentPossible abuse (see comment in text)
Babies Full anterior fontanelle
 Clinical features clearFeatures vague
 Fall < 60 cm or to non-hard surfaceFall from > 60 cm, etc
Action Action
Discharge with age appropriate head injury advice to care of responsible adult with ready access to hospitalObserve 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