If none of these condition are met, consider not ordering CT scan of the head:
- GCS <13 when assessed (irrespective of time post injury)
- GCS <15 two hours post injury (discuss with surgeon)
- Any deterioration in condition
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture
- Post traumatic seizure
- Focal neurological deficit
- >1 episode of vomiting
- Amnesia >30 minutes for events prior to injury
- LOC or amnesia and any of:
- Age >65
- Coagulopathy (bleeding/clotting disorder of anticoagulation, e.g. warfarin)
- High risk mechanism, e.g. pedestrian vs. motor vehicle/ejected from vehicle/fall >1m
- Additional considerations in children
- Early vomiting is more common but ≥3 episodes should be considered significant
- Tense fontanelle
- Bruising, swelling, laceration >5 cm if <1 year old
- NAI
- Abnormal drowsiness
- Anaesthetic and radiation relative risk/benefit. Consult with specialist
Altered conscious level should be attributed to head injury until proven otherwise. The decision to CT should be applied regardless of the influence of intoxication.
