Table 4.

Indications for head CT scan per guidance from SIGN^* and NICE^**

Selection of children (under 16 years) for head CT scan

CT scanning is required if any of the following features: Witnessed loss of consciousness >5 minutes Amnesia (anterograde or retrograde) >5 minutes Abnormal drowsiness ≥3 Discrete episodes of vomiting Clinical suspicion of non-accidental head injury Post-traumatic seizure (no history of epilepsy nor history suggestive of reflex anoxic seizure) GCS <14 on assessment in the emergency department (for a baby under 1 year GCS (paediatric) GCS <15) Suspicion of open or depressed skull injury or tense fontanelle Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign) Focal neurological deficit If under 1 year, presence of bruise, swelling or laceration of >5 cm on the head Dangerous mechanism of injury (high-speed RTA, fall from >3 m height, high-speed injury from a projectile or an object)

CT- Computed tomography, GCS- Glasgow coma scale, PMH- Past medical history, RTA- Road traffic accident.

^*SIGN- Scottish Intercollegiate Guidelines Network,

^**NICE- National Institute of Clinical Excellence