25th June 2023

Investigations

Plain (non-contrast) CT scanning is a key investigation in patients presenting with a head injury. CT has a number of advantages, including being quick and easy to perform, widespread availability, and high sensitivity for picking up intracerebral bleeding.

Intracerebral haemorrhage is one of the most significant complications of head injury. Prompt assessment and investigation are required to identify those with intracerebral bleeding in order to facilitate neuromonitoring, reversal of anticoagulation and surgical treatment where required.

NICE have specific criteria to identify which patients require CT imaging:

For adults who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:

• GCS less than 13 on initial assessment in the emergency department
• GCS less than 15 at 2 hours after the injury on assessment in the emergency department
• Suspected open or depressed skull fracture
• Any sign of basal skull fracture (haemotympanum, “panda” eyes, CSF fluid leakage from the ear or nose, Battle’s sign)
• Post-traumatic seizure
• Focal neurological deficit
• More than one episode of vomiting

For adults who have sustained a head injury with no other indications for a CT head scan and who are having anticoagulant treatment, perform a CT head scan within 8 hours of the injury.