What criteria should I use to decide whether to refer a patient with a head injury for specialist assessment?

Refer a patient with a head injury for specialist assessment if any of the following criteria are met:

• Presence of risk factors for intracranial complications or cervical spine injury, such as a Glasgow Coma Scale (GCS) score of less than 15 on initial assessment, focal neurological deficit, suspicion of complex skull fracture or penetrating head injury, amnesia for events before or after the injury, persistent headache, vomiting episodes, seizure, previous brain surgery, high-energy head injury, bleeding or clotting disorders, anticoagulant or antiplatelet treatment (except aspirin monotherapy), drug or alcohol intoxication, safeguarding concerns, or ongoing concern by the professional about the diagnosis ¹.
• Signs of a suspected open or depressed skull fracture, basal skull fracture, or visible trauma to the scalp or skull, especially in children under 1 year with significant bruising or swelling, or if there is suspected cervical spine injury ².
• If there are persistent or worsening symptoms such as headache, vomiting, or new focal neurological signs, or if there is ongoing concern about the diagnosis, immediate referral is indicated ¹,².
• In children, irritability or altered behaviour, especially in those under 5 years, or if there are safeguarding concerns or non-accidental injury suspected ².

In summary, referral for specialist assessment is warranted when risk factors for intracranial injury or cervical spine injury are present, or if there are signs of serious head injury or worsening symptoms ¹,².