What are the current guidelines for the management of acute subdural haematoma in primary care settings?

Management of Acute Subdural Haematoma in Primary Care Settings

Acute subdural haematoma (ASDH) is a form of traumatic brain injury that requires urgent assessment and management. In primary care or community settings, the key action is to promptly identify and refer patients with suspected ASDH to an emergency department for further evaluation and imaging, typically a CT head scan.

Primary care clinicians should refer any person with a head injury who has any of the following risk factors immediately to hospital using ambulance services if necessary: Glasgow Coma Scale (GCS) less than 15 on initial assessment, any loss of consciousness due to the injury, any focal neurological deficit, suspicion of complex skull fracture or penetrating head injury, persistent headache, vomiting, seizures, previous brain surgery, high-energy head injury, bleeding or clotting disorders, current anticoagulant or antiplatelet treatment (except aspirin monotherapy), drug or alcohol intoxication, safeguarding concerns, or continuing clinical concern about the diagnosis ².

CT imaging is the primary investigation of choice to detect acute clinically important traumatic brain injury such as ASDH and should be performed urgently in secondary care ². MRI is not recommended as the primary investigation in this context ².

Primary care providers should not attempt to manage ASDH themselves but ensure rapid transfer and communication with emergency and neurosurgical services. If imaging shows surgically significant abnormalities, discussion with a neurosurgeon is essential ².

Effective initial assessment includes documentation using a standard head injury proforma and consideration of safeguarding issues ².

In summary, the current UK guidelines emphasize urgent referral of suspected acute subdural haematoma cases from primary care to hospital emergency departments for CT imaging and specialist management, with no role for primary care in definitive diagnosis or treatment ².