Acute management of head injury

Head injury in infants and children is common and the majority of cases have mild/minor injury. After emergency treatment has been given, the clinical priority at the time of assessment includes in the acutely ill, identifying and treating the small proportion that will go on to have serious intracranial complications; in the mild/minor cases, identifying those at risk of physical, emotional and cognitive complications of concussion; and in the young infants, identifying those suffering inflicted or non-accidental injury and initiating appropriate child protection procedures. In all patients, initial assessment should occur within 15 min of arrival at the emergency department. There are now useful decision rules to guide when to undertake cranial imaging as well as management standards to help with emergency support. Subsequent admission should be supervised by a team led by a specialist in the management of head injury. When transfer to a clinical neurosciences unit is required it is important that any communication should use the three separate responses of the Glasgow Coma Scale score to describe the patient. Later, follow-up is required and the family practitioner should be informed of the admission and need for an assessment within one week of discharge. Long-term effects of head injury and postconcussion syndrome will require specialist support.