GPAtlas🧭 When to suspect
A head injury is any trauma to the head other than a superficial facial injury, and includes both closed and penetrating injuries. The reassuring background fact is that the vast majority are minor and settle with rest; only a small minority conceal a serious intracranial injury. The two skills that matter in primary care are therefore to recognise who needs emergency assessment, and to safely manage everyone else at home with supervision and clear safety-netting.
A crucial structural point: a GP cannot request a CT (computed tomography) head scan directly from the community – the imaging decision and the scan itself happen in the emergency department (ED). The primary-care task is recognition and timely referral, not investigation. The Glasgow Coma Scale (GCS) – a score from 3 to 15 of eye, verbal and motor response, where 15 is fully alert – is the common shorthand for conscious level throughout.
Hold a lower threshold to refer in the higher-risk groups: anyone on an anticoagulant or a non-aspirin antiplatelet, those with a bleeding or clotting disorder, age 65 or over, a dangerous mechanism, previous neurosurgery or a CSF shunt, or intoxication (which clouds the assessment).
| Severity (by GCS) | GCS | Typical picture |
|---|---|---|
| Mild | 13–15 | Brief or no loss of consciousness; the large majority; “concussion” sits here |
| Moderate | 9–12 | Reduced consciousness; needs emergency assessment and CT |
| Severe | ≤ 8 | Coma; airway at risk; major-trauma pathway |
Source: NICE NG232
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