The Purple Book

Head Injury

• Glasgow Coma Scale (GCS) score <15 on initial assessment
• any loss of consciousness because of the injury
• any focal neurological deficit since the injury
• any suspicion of a complex skull fracture or penetrating head injury since the injury
• amnesia for events before or after the injury (it will not be possible to assess amnesia in children who are preverbal and is unlikely to be possible in children under 5)
• a persistent headache since the injury
• any vomiting episodes since the injury (use clinical judgement about the cause of vomiting in children 12 years or under and the need for referral)
• any seizure since the injury
• any previous brain surgery
• a high-energy head injury
• any history of bleeding or clotting disorders
• current anticoagulant or antiplatelet (except aspirin monotherapy) treatment
• current drug or alcohol intoxication
• any safeguarding concerns (for example, possible non-accidental injury or a vulnerable person is affected)

In the absence of any of the above, consider referral if:

• irritability or altered behaviour, particularly in babies and children under 5
• visible trauma to the head not covered in recommendation 1.2.4 but still of concern to the professional
• no one is able to observe the injured person at home
• continuing concern by the injured person, or their family or carer, about the diagnosis.