Head injury — NICE NG232 referral and CT criteria

What it is for

Head injury seen in general practice or by phone. NICE NG232 (2023). The ED-referral criteria apply to all ages; the CT criteria shown are the adult ones (children have separate criteria in NG232). Reference only — the CT decision is made by the emergency department.

What you enter

The calculator asks for 28 items.

A. Referral from the community to an emergency department (NG232) — any of:

• GCS less than 15 on initial assessment
• Any loss of consciousness as a result of the injury
• Any focal neurological deficit since the injury
• Any suspicion of a skull fracture or penetrating head injury
• Amnesia for events before or after the injury
• Persistent headache since the injury
• Any vomiting episodes since the injury (clinical judgement in young children)
• Any seizure since the injury
• Any previous brain surgery
• A high-energy head injury (e.g. pedestrian struck by a vehicle, ejected from a vehicle, fall from > 1 m or > 5 stairs)
• Any history of bleeding or clotting disorders
• Current anticoagulant or antiplatelet treatment (except aspirin monotherapy)
• Current drug or alcohol intoxication
• Safeguarding concerns (including suspected non-accidental injury)
• Irritability or altered behaviour, particularly in infants and children under 5
• Continuing concern by the professional about the diagnosis

B. Adults — CT head within 1 hour of risk factor identified (as assessed in ED) — any of:

• GCS less than 13 on initial assessment in the emergency department
• GCS less than 15 at 2 hours after the injury
• Suspected open or depressed skull fracture
• Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, CSF from ear or nose, Battle’s sign)
• Post-traumatic seizure
• Focal neurological deficit
• More than 1 episode of vomiting

C. Adults — CT head within 8 hours: loss of consciousness or amnesia since the injury AND any of:

• Loss of consciousness or amnesia since the injury (required for this section)
• Age 65 or over
• History of bleeding or clotting disorders
• Dangerous mechanism of injury
• More than 30 minutes’ retrograde amnesia of events immediately before the injury

How the result is read

The result is shown as NG232 criteria met.

Sources

These are the sources the calculator cites. Check the current version before relying on a threshold.

• NICE NG232 Head injury: assessment and early management (2023)
• Stiell et al. Lancet 2001 — Canadian CT Head Rule

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