Head Injury and NAI

For children who have sustained a head injury and have any of the following risk factors,

perform a CT head scan within 1 hour of the risk factor being identified:

1.Suspicion of non-accidental injury.

2.Post-traumatic seizure but no history of epilepsy.

3.On initial emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15.

4.At 2 hours after the injury, GCS less than 15.

5.Suspected open or depressed skull fracture or tense fontanelle.

6.Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid

7.leakage from the ear or nose, Battle’s sign).

8.Focal neurological deficit.

9.For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head.

OR if more than one of the following:

1.Loss of consciousness lasting more than 5 minutes (witnessed).

2.Abnormal drowsiness.

  1. Three or more discrete episodes of vomiting.
  2. Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 metres, high-speed injury from a projectile or other object).

5. Amnesia (antegrade or retrograde) lasting more than 5 minutes

Features of “Shaken baby syndrome”

1.Peak incidence 5 months of age

2.History inconsistent with injury

May present collapsed,

Key Points:

Presentation depends upon the age of the child

Strength of evidence Recommendation grade

The meta-analysis and cohort study clearly demonstrate that young children (3 years and under) with brain tumours present very differently to older children.”

  • Consider a brain tumour in any child presenting with a new persistent headache. (A continuous or recurrent headache lasting for more than 4 weeks should be regarded as persistent)
    Strength of evidence

Recommendation grade Consensus achieved Rationale


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