management of head injuries

Last edited 05/2023 and last reviewed 05/2023

The management of head injuries is directed towards preventing the secondary causes of brain damage.

There is a set plan for the management of head injuries:

• observation of normal ATLS protocols
• assessment of severity of injury
• assessment of need for skull x-ray
• assessment of need for admission
• assessment of need for neurological consultation
• management of consequences of injury

Additional factors that must be borne in mind in the management are alcohol intoxication, diabetes, MI, strokes and epilepsy.

Tranexamic acid use in head injury

• for people with a head injury and a GCS score of 12 or less who are not thought to have active extracranial bleeding, consider (3):
  • a 2 g intravenous bolus injection of tranexamic acid for people 16 and over
  • a 15 mg/kg to 30 mg/kg (up to a maximum of 2 g) intravenous bolus injection of tranexamic acid for people under 16
    
    
  • give the tranexamic acid as soon as possible within 2 hours of the injury, in the pre-hospital or hospital setting and before imaging

Notes (1):

• priority for all emergency department patients is the stabilisation of airway, breathing and circulation (ABC) before attention to other injuries
• depressed conscious level should be ascribed to intoxication only after a significant brain injury has been excluded
• all emergency department clinicians involved in the assessment of patients with a head injury should be capable of assessing the presence or absence of the risk factors in the guidance on patient selection and urgency for imaging
• patients presenting to the emergency department with impaired consciousness (GCS less than 15) should be assessed immediately by a trained member of staff
• in patients with a GCS less than or equal to 8 there should be early involvement of an anaesthetist or critical care physician to provide appropriate airway management
• all patients presenting to an emergency department with a head injury should be assessed by a trained member of staff within a maximum of 15 minutes of arrival at hospital

Reference:

1. NICE (September 2007). Triage, assessment, investigation and early management of head injury in infants, children and adults.
2. NICE (January 2014). Triage, assessment, investigation and early management of head injury in infants, children and adults
3. NICE (May 2023). Head injury - Triage, assessment, investigation and early management of head injury in children, young people and adults