How should I approach the investigation of a suspected subdural haematoma in a patient with a history of head trauma?

Approach to investigating suspected subdural haematoma in a patient with head trauma:

• Perform an urgent CT head scan as the primary investigation to detect acute clinically important traumatic brain injury, including subdural haematoma, in any patient with a history of head trauma and clinical suspicion ¹.
• Use clinical decision rules to identify patients who require CT imaging promptly, such as those with loss of consciousness, abnormal drowsiness, persistent vomiting, amnesia, or on anticoagulant/antiplatelet therapy ¹.
• Ensure CT imaging is done within 1 hour for patients under 16 with multiple risk factors or within 8 hours for adults on anticoagulants, or sooner if presenting late after injury ¹.
• Do not use MRI as the primary investigation for acute traumatic brain injury due to safety and logistic reasons, but it may provide additional prognostic information ¹.
• Do not use plain skull X-rays to diagnose traumatic brain injury before consulting a neuroscience unit ¹.
• After imaging, if new and surgically significant abnormalities such as subdural haematoma are identified, discuss the case urgently with a neurosurgeon for management planning ¹.
• Admit patients with clinically important abnormalities on imaging or with persistent neurological symptoms for observation and specialist care ¹.