Head Injury

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National Collaborating Centre
for Acute Care

Head Injury
Triage, assessment, investigation and
early management of head injury
in infants, children and adults

METHODS, EVIDENCE & GUIDANCE

SEPTEMBER 2007

Commissioned by the National Institute
for Health and Clinical Excellence

Head Injury: triage, assessment,
investigation and early management of
head injury in infants, children and adults.

METHODS, EVIDENCE & GUIDANCE

Head Injury: triage, assessment, investigation and early management of head injury in infants, children and adults.

2

Published by the National Collaborating Centre for Acute Care at The Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London, WC2A 3PE First published June 2003

© National Collaborating Centre for Acute Care 2007
Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

The rights of National Collaborating Centre for Acute Care to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

ISBN 0-9549760-5-3

Head Injury: triage, assessment, investigation and early management of head injury in infants, children and adults.

3

Foreword
Updating a document can be more difficult than starting from scratch; certainly we have found incorporation of new evidence into the guideline first published by NICE four years ago to be more complex than initially envisaged. I thank the Guideline Development Group and the team at the National Acute Care Collaboration Centre for their enthusiastic and professional support and advice throughout this process. We have been helped in our task by contributions from patient groups and stakeholders. The final document is undoubtedly richer as a result of the extensive consultations which followed the publication of the first draft.

Perhaps the most important prompt for this update was the publication of validation studies related to the advice on CT imaging; one of the most significant components of the first guidance. New research evidence on the management of paediatric head injuries was also available and this has been particularly useful in clarifying the subtle differences in guidance for adults and children.

Emerging evidence on the value of CT in cervical spine imaging – and the increasing awareness that plain films may not reveal clinically important lesions – has led the Guideline Development Group to recommend greater use of CT in the assessment of the neck in those head injured patients who have impaired consciousness. The transfer of critically ill or injured patients between hospitals is rarely out of the news and it has been an agenda item at our meetings throughout the update process. There are two issues. Should ambulances “by pass” local hospitals en route from the scene of an incident to reach a specialist centre? Secondly, if all patients continue, as at present, to be transported to the nearest hospital, what are the indications for “secondary transfer”? The evidence in both areas is weak – but there is more than there was four years ago. On balance the Guideline Development Group consider the case for transferring all seriously head injured patients to a specialist...
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