Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical signs indicating the need for immediate CT imaging in a patient with suspected traumatic brain injury include:
- A Glasgow Coma Scale (GCS) score of 12 or less on initial assessment in the emergency department.
- A GCS score of less than 15 at 2 hours after the injury.
- Suspected open or depressed skull fracture.
- Any sign of basal skull fracture such as haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, or Battle's sign.
- Post-traumatic seizure.
- Focal neurological deficit.
- More than one episode of vomiting.
For patients who have had some loss of consciousness or amnesia since the injury, additional risk factors prompting imaging within 8 hours include:
- Age 65 or over.
- Any current bleeding or clotting disorders.
- Dangerous mechanism of injury (e.g., pedestrian or cyclist struck by a motor vehicle, occupant ejected from a motor vehicle, or fall from height greater than 1 meter or 5 stairs).
- More than 30 minutes of retrograde amnesia immediately before the injury.
In children under 16, immediate imaging is indicated with:
- Suspicion of non-accidental injury.
- Post-traumatic seizure.
- GCS score less than 14 on initial assessment (or less than 15 for babies under 1 year).
- GCS score less than 15 at 2 hours after injury.
- Suspected open or depressed skull fracture or tense fontanelle.
- Any sign of basal skull fracture.
- Focal neurological deficit.
- For babies under 1 year, a bruise, swelling, or laceration of more than 5 cm on the head.
These signs warrant a CT head scan within 1 hour of identification to detect clinically important traumatic brain injury and guide further management NICE NG232.