*Head injury - CT head indications

Question 1

What are the criteria for a CT head within 1hr?

Answer 1

• GCS <13 on initial assessment in the emergency department.
• GCS <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 leakage from ear or nose, Battle’s sign).
• Post-traumatic seizure.
• Focal neurological defici
• > 1 episode of vomiting

Question 2

What are the criteria for CT head within 8 hours?

Answer 2

• Age 65 years or older.
• Any history of bleeding or clotting disorders.
• Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs).
• > 30 minutes’ retrograde amnesia of events immediately before the head injury.

Question 3

Within what time frame should the CT head report be back?

Answer 3

Within 1hr for both the <1hr and <8hr scans

Question 4

Within what time frame should a scan be performed if a patient on warfarin has a head injury?

Answer 4

If a patient is on warfarin who have sustained a head injury with no other indications for a CT head scan, perform a CT head scan within 8 hours of the injury.

Question 5

What imaging and when, should be offered for a patient on warfarin who has had TIA symptoms?

Answer 5

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be admitted immediately for imaging (CT) to exclude a haemorrhage