Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
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  2. Urgent care
  3. Injuries & musculoskeletal
  4. Minor head injury
● Urgent care clinic · 30-minute consult

Minor head injury

Who needs a CT and who can go home with advice.

Typical consult⏱ 20 min
Investigations🔬 CT head only if NICE criteria met
Usual outcome💊 Head injury advice + responsible adult
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
If you find……then
GCS < 15 at 2 hours, or < 13 at any timeCT within 1 h
Suspected open/depressed or basal skull fracture (panda eyes, Battle’s sign, CSF leak, haemotympanum)CT within 1 h
Post-traumatic seizure, focal neurology, more than 1 episode of vomitingCT within 1 h
On anticoagulants (not aspirin alone)CT within 8 h
Loss of consciousness or amnesia AND (age ≥ 65, bleeding disorder, dangerous mechanism, or > 30 min retrograde amnesia)CT within 8 h
Concern about non-accidental injury or no one at homeDon’t discharge — safeguarding / observation
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan

NICE NG232 CT head criteria (adults)

  • Within 1 h: GCS < 13 initially, or < 15 at 2 h
  • Within 1 h: suspected open/depressed/basal skull fracture
  • Within 1 h: post-traumatic seizure, focal deficit, > 1 vomit
  • Within 8 h: anticoagulant use
  • Within 8 h: LOC/amnesia + age ≥ 65, bleeding disorder, dangerous mechanism, or > 30 min retrograde amnesia

None present → no CT. Discharge only with a responsible adult and written advice. Children have separate NG232 criteria.

InvestigationOnly if…
CT headOnly if NG232 criteria met
No routine bloodsClotting only if on anticoagulants / bleeding disorder
5Treat & send home

Management & advice

  • Discharge with a responsible adult for the first 24 h
  • Written head-injury advice (QR below)
  • Rest, avoid alcohol and sleeping tablets for 24–48 h
  • Return to work, study and sport gradually; no contact sport until symptom-free (graded return)
  • No driving until fully recovered

Refer / follow-up

  • Persisting post-concussion symptoms > 2 weeks → GP
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
DrugDoseDuration / notes
Paracetamol1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)As needed
6Safety-net
Say it like this

You don’t need a scan using the national guidance. You should have someone with you for the next 24 hours. Headache, tiredness and feeling a bit off are common for a few days. Call 999 or come straight back if you become very drowsy, vomit again and again, the headache gets much worse, you have a fit, or you develop weakness or problems speaking or seeing.

Come back / call 111 — or 999 if severe — if:

  • Becoming drowsy or hard to wake
  • Repeated vomiting
  • Worsening or severe headache
  • Confusion, weakness, problems with speech, vision or balance
  • Fit or seizure; clear fluid from ears or nose
7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Head injury and concussionnhs.uk/conditions/head-injury-and-concussion
8Document

Minor head injury — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — MINOR HEAD INJURY PRESENTING COMPLAINT: HISTORY Mechanism and time; height of fall; speed: Loss of consciousness? Amnesia before/after?: Headache, vomiting (how many times), seizure: Anticoagulants / antiplatelets; bleeding disorders: Alcohol or drugs: Who is at home tonight?: RED FLAGS (record present / absent) [ ] GCS < 15 at 2 hours, or < 13 at any time [ ] Suspected open/depressed or basal skull fracture (panda eyes, Battle’s sign, CSF leak, haemotympanum) [ ] Post-traumatic seizure, focal neurology, more than 1 episode of vomiting [ ] On anticoagulants (not aspirin alone) [ ] Loss of consciousness or amnesia AND (age ≥ 65, bleeding disorder, dangerous mechanism, or > 30 min retrograde amnesia) [ ] Concern about non-accidental injury or no one at home PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION GCS (and repeat), pupils: Scalp: haematoma, laceration, step: Basal skull signs: Full neurological examination: C-spine assessment (Canadian rule): DECISION RULE — NICE NG232 CT head criteria (adults): result ______ INVESTIGATIONS: none required / CT head, No routine bloods — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Head injury and concussion Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Becoming drowsy or hard to wake - Repeated vomiting - Worsening or severe headache - Confusion, weakness, problems with speech, vision or balance - Fit or seizure; clear fluid from ears or nose Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More injuries & musculoskeletal

Ankle & foot injuryTwisted ankle or foot — Ottawa rules decide the X-ray.Knee injuryTwisting or direct knee injury — Ottawa knee rule, spot the ACL and locked knee.Wrist injury & scaphoidFall on the outstretched hand — distal radius vs scaphoid.Hand & finger injuryBoxer’s fracture, mallet finger, crush injuries and the hand you must not miss.