Table 3

 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)