Transferring Patients from ED after a Head Injury

  • 1. To a neuroscience department in the local area

    Significant head injury (GCS is less than 8) warrants transfer to the local area neuroscience department. This is a complex transfer requiring intubation and ventilation usually, meaning the anaesthetist must accompany the patient with the ambulance crew.

    Other patients requiring transfer will be those with evidence of significant injury on the CT scan or those behaving irregularly. These patients will require their scans to be shared with the tertiary neuroscience department ahead of transfer.

  • 2. Admission and observation to hospital

For the following reasons:

  • Patient with new significant abnormality on imaging

  • Patient whose GCS has not satisfactorily returned to 15 regardless of an imaging being normal

  • If a CT is required but delayed for any reason (i.e scanner availability or patient non-compliance)

  • Ongoing worrying signs such as vomiting

  • Other causes of concern to clinician which do not warrant transfer to specialist neuroscience department

    Patients who are admitted should have ‘neuro observations’ – these are different to regular nursing observations and include GCS, pupil size and limb movements in addition to regular nursing observations (respiratory rate, pulse, blood pressure, temperature and oxygen sats).

    Neuro observations should be directly requested to be done by nursing staff every 30 minutes until GCS 15, then every 1 hour for 4 hours, and then 2 hourly thereafter. Any deterioration including agitation, confusion, vomiting, new neurological symptoms or decreasing GCS requires full reassessment by doctor, and will require assessment for CT head.

  • 3. Discharged patient with follow up

    Patients may be discharged if they are considered to be low risk without requiring a CT head, or following a normal CT head scan and a GCS score of 15 in the department.

  • Patients should only be transferred home if they have someone there to observe/supervise them. Patients MUST be given verbal and written advice detailing that someone accompanies them home and is with them for a minimum 24 hours. They MUST also be told the risk factors to warrant a return to the emergency department – this allows safety for those re-attending within 48 hours to have a priority assessment and be considered for a CT scan as urgent if required.

    Written head injury advice cards can be found online and must be given out, and all discharge advice should be documented in the ED notes.