Treatment Plan
Treatment Plan
Immediate ED referral if:
- GCS <15 on initial assessment
- Evidence of shock/significant trauma
- Dangerous mechanism: falls >1m/5 stairs, RTA, car ejection/rollover
- History of bleeding/coagulation disorders or concurrent anticoagulant medication
- Post-traumatic seizures
- Focal neurology/ Paraesthesia in extremities
- Suspected skull fractures
- No responsible adult for 24-hour monitoring
- Loss of consciousness after injury
- Amnesia >5 mins
- Persistent Headache since
- Post-head trauma vomiting
- Signs of basal skull fracture: hemotympanum, panda eyes, battle signs, CSF leak
- Safeguarding concerns
- Visible injury >5cm (children)
- Altered behaviour (children)
- Irritability (children)
- Bulging anterior fontanelle Neck pain/tenderness
If no immediate referral is needed:
- 24-hour monitoring by responsible adult
- Strong safety netting advice
- 4-hour observation period for children not meeting admission criteria
For suspected cervical injury:
- Neck immobilisation if: GCS <15, neck tenderness, focal neurology, paraesthesia
Complications
Post-concussion syndrome may develop if symptoms persist >3 months: needs referral