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
• 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 cerebrospinal fluid (CSF) shunt
• 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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