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Intracranial injury red flags — MRCEM SBA MCQ

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HardConcussionIntracranial injury red flagsMRCEM SBA

A 74-year-old taking apixaban falls and strikes his head. He presents 3 hours after injury, has GCS 15, no vomiting, amnesia, focal deficit or loss of consciousness, and no other NICE indication for CT. What is the best imaging plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Arrange non-contrast cranial computed tomography within eight hours of injury

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

A is correct. NICE advises considering CT within 8 hours for a person on anticoagulants even when no other CT criterion is present; if presentation is more than 8 hours after injury, scanning is considered within 1 hour. B ignores anticoagulant risk. C INR does not measure apixaban effect and is not the rule. D skull radiography cannot replace CT. E delayed outpatient imaging does not meet the recommended acute assessment window.

Reference: NICE NG232, Head injury: assessment and early management: https://www.nice.org.uk/guidance/NG232/chapter/recommendations