What are the key clinical signs that indicate a need for immediate imaging in a patient with suspected traumatic brain injury?

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 ¹.