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Head injury - Management
Who should I refer to hospital?

  • Refer immediately to the hospital emergency department using the ambulance service if necessary, if there is (or has been):
    • An altered level of consciousness. This can be objectively assessed using the Glasgow Coma Scale; any score of 14 or less (out of a maximum score of 15) indicates emergency referral.
    • Any loss of consciousness after the injury (even if they are fully alert on presentation).
    • A seizure since the injury.
    • Evidence of focal neurological deficit, such as:
      • Problems with sight, speech, understanding speech, reading, or writing.
      • Problems with balance or walking.
      • Loss of muscle power.
      • Paraesthesia of the extremities.
    • Amnesia for events before or after the injury.
    • Any suspicion of a skull fracture, such as:
      • Clear fluid (possible cerebrospinal fluid) running from the ear or nose.
      • A black eye with no damage around the eye.
      • Bleeding from one or both ears; blood behind the ear drum; new deafness in one or both ears; or bruising behind one or both ears.
      • Signs of a penetrating injury.
      • Visible trauma to the scalp or skull that is of concern.
    • Evidence of shock, or other injuries such as chest or abdominal trauma, limb or pelvic trauma, or significant vascular injury.
    • Persistent headache since the injury.
    • Vomiting since the head injury.
      • More than one episode in an adult.
      • Three or more episodes in a child.
    • A high-energy head injury such as: a pedestrian being struck by a motor vehicle; a high-speed motor collision; an axial-loading injury such as diving; a 'rollover' motor accident; or a fall from a height of greater than 1 metre, or more than five stairs.
    • A previous history of brain surgery.
    • A bleeding or clotting disorder, or current anticoagulant treatment (such as warfarin).
    • Suspicion the person has taken drugs or is intoxicated with alcohol.
    • A person 65 years of age or older.
    • Suspicion of a non-accidental injury.
    • Continuing concern about the diagnosis by the healthcare professional.
  • If the criteria listed above are not met, consider referral to a hospital emergency department if there is:
    • Irritability or altered behaviour, particularly in infants and children.
    • Adverse social factors that may affect safety at home.
    • Continuing concern about the diagnosis by the injured person, or their carer.
  • The person may be sent home if:
    • Clinical history and examination indicate a low risk of brain injury and the referral criteria are not met.
    • They have appropriate support structures and competent supervision at home.
    • They have received verbal and written self-care advice.

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