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CT Head Decision Tool for Trauma

Paediatric Patients (Under 16) - Based on NICE Guidelines

For authorized healthcare professionals only

CT Head Decision Tool For Trauma

Based on NICE Guidelines - Paediatric Patients (Under 16)

Based on NICE Guidelines
Children & Young People
Assessment Progress Step 1 of 6

CT Head Imaging Assessment For Trauma

Based on NICE Guidelines for Children & Young People Under 16 Years

Algorithm 2: Selecting people under 16 for a CT head scan

Important Notice

This tool is for healthcare professionals only. It should be used alongside clinical judgement and does not replace professional medical assessment.

Patient Criteria

Patient under 16 years old
Presenting to ED with head injury

High-Risk Factors Assessment

Are ANY of these high-risk factors present?

If any factor is present, CT head scan is required within 1 hour

Suspicion of non-accidental injury

Clinical concern for intentional harm

Post-traumatic seizure (no history of epilepsy)

New seizure activity following head injury

GCS score less than 14 on initial assessment (or GCS paediatric score less than 15 for children under 1 year)

Altered level of consciousness - age-appropriate criteria

GCS score less than 15 at 2 hours after injury

Persistent altered consciousness

Suspected open or depressed skull fracture, or tense fontanelle

Visible skull damage or increased intracranial pressure

Signs of basal skull fracture

Haemotympanum, 'panda' eyes, CSF leak, Battle's sign

Focal neurological deficit

Localised neurological symptoms or signs

For children under 1 year: Bruise, swelling or laceration > 5 cm on head

Significant scalp injury in infants

Secondary Risk Factors Assessment

Review the secondary risk factors below and select your assessment

You may tick factors for reference, then choose the appropriate action below

Please select the appropriate action based on your assessment:

Observation Period Assessment

Observe for at least 4 hours after the head injury

Monitor for development of concerning symptoms during observation

During the 4-hour observation period, are ANY of these risk factors present?

GCS score of less than 15

Deterioration in consciousness level

Further vomiting

New episodes of vomiting during observation

Further episodes of abnormal drowsiness

Continued abnormal/excessive drowsiness

Anticoagulation & Antiplatelet Assessment

Are they taking anticoagulants or antiplatelets?

This affects bleeding risk and scan timing requirements

Anticoagulants include:

  • • Vitamin K antagonists (e.g., warfarin)
  • • Direct-acting oral anticoagulants (DOACs)
  • • Heparin and low molecular weight heparins

Antiplatelets include:

  • • Clopidogrel, dipyridamole, etc.
  • • Excluding aspirin monotherapy

Clinical Recommendation

Important Notes

  • • All CT scans require provisional written radiology report within 1 hour
  • • Use clinical judgement to determine further observation needs
  • • This tool supports but does not replace clinical assessment
  • • Consider patient-specific factors and clinical context