What are the key indications for urgent referral to secondary care in patients with altered levels of consciousness?

Key indications for urgent referral to secondary care in patients presenting with altered levels of consciousness include:

• Glasgow Coma Scale (GCS) score less than 15 on initial assessment, indicating impaired consciousness.
• Any loss of consciousness related to head injury, even if the person has now recovered.
• Presence of any focal neurological deficit since the injury.
• Suspicion of complex skull fracture or penetrating head injury.
• Any seizure (convulsion or fit) since the injury.
• High-energy head injury mechanism.
• Current anticoagulant or antiplatelet treatment (except aspirin monotherapy), or history of bleeding or clotting disorders.
• Current drug or alcohol intoxication affecting consciousness.
• Any safeguarding concerns, such as possible non-accidental injury or vulnerability.
• Persistent headache, vomiting episodes, or amnesia for events before or after the injury.
• Continuing concern by healthcare professionals or helpline staff about the diagnosis or clinical condition.

Additionally, adults with new-onset blackouts accompanied by features suggestive of epileptic seizures should be referred urgently for neurological assessment.

Sudden-onset dizziness with focal neurological deficits or acute vestibular syndrome with signs suggestive of stroke also warrant immediate referral.

These criteria ensure timely assessment and management of potentially serious neurological conditions presenting with altered consciousness.

References: ¹,²