Table 2.

2014 NICE guidelines on paediatric head injury³⁷

Recommendation 1.4.9

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

Suspicion of non-accidental injury

Post-traumatic seizure but no history of epilepsy

On initial emergency department assessment, GCS <14, or for children under 1 year GCS (paediatric) <15

At 2 h after the injury, GCS <15

Suspected open or depressed skull fracture 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

For children below 1 year of age, presence of bruise, swelling or laceration of >5 cm on the head

Recommendation 1.4.10

For children who have sustained a head injury and have more than one of the following risk factors (and none of those in Recommendation 1.4.9), perform a CT head scan within 1 h of the risk factors being identified

Loss of consciousness lasting more than 5 min (witnessed)

Abnormal drowsiness

Three or more discrete episodes of vomiting

Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of >3 m, high-speed injury from a projectile or other object)

Amnesia (antegrade or retrograde) lasting more than 5 min4

Recommendation 1.4.11

Children who have sustained a head injury and have only one of the risk factors in Recommendation 1.4.10 (and none of those in Recommendation 1.4.9) should be observed for a minimum of 4 h after the head injury. If, during observation, any of the risk factors mentioned below are identified, perform a CT head scan within 1 h

GCS l <15

Further vomiting

A further episode of abnormal drowsiness

GCS, Glasgow Coma Scale.