What are the indications for referring a patient with ICP to a specialist, and what information should I include in the referral?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Indications for referring a patient with increased intracranial pressure (ICP) to a specialist include:

  • Persistent or worsening clinical features after head injury such as vomiting, headaches, or new-onset focal neurological signs indicating possible complications ,.
  • Glasgow Coma Scale (GCS) score less than 15 on initial assessment .
  • Any loss of consciousness due to injury .
  • Any focal neurological deficit since the injury .
  • Suspected open or depressed skull fracture, basal skull fracture, or penetrating head injury ,.
  • Amnesia for events before or after the injury .
  • Seizure since the injury .
  • High-energy head injury .
  • History of bleeding or clotting disorders or current anticoagulant/antiplatelet treatment (except aspirin monotherapy) ,.
  • Clinical suspicion of subarachnoid haemorrhage, especially with thunderclap headache or neurological signs .
  • Signs of increased ICP such as altered consciousness, neck stiffness, photophobia, nausea, vomiting, or new neurological deficits .
  • Any safeguarding concerns or suspicion of non-accidental injury .

Information to include in the referral:

  • Patient demographics and presenting symptoms including onset, duration, and progression of symptoms ,.
  • Details of the injury or precipitating event, including mechanism and timing ,.
  • Neurological examination findings including GCS score, focal neurological signs, and any seizures ,.
  • Relevant medical history such as previous brain surgery, bleeding/clotting disorders, and current medications including anticoagulants ,.
  • Results of any investigations performed, such as CT head scan findings if available .
  • Any concerns about safeguarding or vulnerability .
  • Contact details of the referring clinician and confirmation that a competent adult will accompany the patient if transfer is urgent .

Referral should be made urgently to an emergency department or specialist neurosurgical centre depending on severity, with prior telephone notification to the receiving hospital ,.

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Educational content only. Always verify information and use clinical judgement.