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Injuries Neurological

Head injury

Last revised in July 2026

Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury

Head injury: Summary

  • Head injury is defined as any trauma to the head other than superficial injuries to the face.
    • Traumatic brain injury occurs when head injury results in a disturbance of normal brain function and can be categorized as mild (also known as concussion), moderate, or severe.
  • In the UK, head injury is the commonest cause of death and disability in people aged 1–40 years.
    • Other complications of head injury include intracranial lesions (such as extradural or subdural haematoma and subarachnoid haemorrhage), skull fracture, seizures, hypopituitarism, mood disorders, and cognitive impairment.
  • The initial aim of assessment of head injury in primary care is to rapidly identify risk factors for intracranial complications or cervical spine injury.
    • Basic and advanced adult or paediatric trauma life support protocols should be followed with appropriate interventions as indicated.
  • Immediate referral (accompanied by a competent adult) to a hospital emergency department should be arranged if any of the following are identified:
    • GCS score of less than 15 on initial assessment.
    • Evidence of shock or significant injury.
    • Dangerous mechanism of head injury.
    • A history of bleeding or coagulation disorders, current anticoagulant or antiplatelet (except aspirin monotherapy) medication.
    • Current alcohol or drug intoxication.
    • Any loss of consciousness after the injury (even if fully alert on presentation).
    • Any post-traumatic seizure.
    • Any previous brain surgery.
    • Amnesia for events before or after the injury.
    • Persistent headache since the injury.
    • Any vomiting since the injury.
    • Any focal neurological deficit since the injury.
    • A suspected open or depressed skull fracture, or tense fontanelle in a child.
    • A suspected basal skull fracture.
    • Signs of a penetrating injury or visible trauma to the scalp or skull — in children under 1 year of age, a bruise, swelling, or laceration of more than 5 cm on the head.
    • Suspected cervical spine injury — full cervical spine immobilization should be arranged before transfer to the hospital.
    • Irritability or altered behaviour, particularly in infants and children aged under 5 years.
    • Clinical concern or concern by the person or their family/carers.
    • A responsible adult is unable to stay with the person for the first 24 hours after the injury.
    • Possible non-accidental injury, safeguarding concerns, or a vulnerable person is affected.
  • For all other children and adults who are at low risk of an intracranial complication or cervical spine injury:
    • Advise that a responsible adult should stay with the person for the first 24 hours after the injury and remain alert for worrying signs and symptoms which indicate the need for urgent medical review. These may include focal neurological deficits, symptoms indicative of a complex skull fracture, or non-specific symptoms such as persistent headaches, vomiting, irritability or altered behaviour.
    • Give the person and/or family/carers verbal and written information and self-care advice.
    • Be aware of specific guidelines for timing of return to play in sports-related head injury.
  • Referral to an appropriate specialist should be arranged if:
    • There are persistent non-specific symptoms for more than 3 months.
    • Another complication or cause of head injury is suspected.
    • There are concerns or uncertainty about the nature or severity of symptoms.

Have I got the right topic?

From birth onwards.

This CKS topic covers the management of people with head injury in primary care.

This CKS topic does not cover the management of other trauma that may be associated with the head injury, or the management of head injury in secondary care.

There are separate CKS topics on Alcohol - problem drinking, Child maltreatment - recognition and management, Delirium, Falls - risk assessment, Neck pain - whiplash injury, Opioid dependence, and Post-traumatic stress disorder.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

July 2026 — reviewed. A literature search was conducted in June 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to the topic, including the addition of new background information sections summarizing prevalent causes and risk factors related to head injury. Guidance about considering further investigations or referral for people with persistent symptoms consistent with hypopituitarism have been added to the topic, to align with updated NICE guidance. Guidance about returning to sport, work and school post-injury has been updated to align with the 2022 International Consensus Statement on Concussion in Sports and UK Government guidance.

Previous changes

July 2021 — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.

July 2016 — reviewed. A literature search was conducted in June 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has undergone minor restructuring. The recommendations on risk factors to consider when assessing a person with a head injury, and the recommendations on full cervical spine immobilization have been amended in line with the National Institute for Health and Care Excellence (NICE) guideline Head injury: assessment and early management (2014). In addition, the Complications section has been expanded and the Prognosis section has been added.

July 2011 — minor update to assessment of head injury to clarify when to suspect non-accidental head injury in a child. Issued in September 2011.

August 2009 — minor update. Advice from the National Institute for Health and Care Excellence (NICE) guideline Child maltreatment: when to suspect maltreatment in under 18s (2009) has been added to this topic. Issued in August 2009.

July 2009 — Minor update to the Basis for recommendation in the section on Referral. The reason why NICE recommend referral for people over 65 years of age has been clarified. Issued in July 2009.

March 2009 — updated to include information on hypopituitarism following traumatic brain injury. Issued in April 2009.

September 2008 to February 2009 — this is a new CKS topic. The evidence-base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 July 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 July 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 July 2026.

Systematic reviews and meta-analyses

No new systematic review or meta-analyses since 1 July 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 July 2026.

New policies

No new national policies or guidelines since 1 July 2026.

New safety alerts

No new safety alerts since 1 July 2026.

Changes in product availability

No changes in product availability since 1 July 2026.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Assess a person who has sustained a head injury.
  • Identify people who require immediate referral to the hospital emergency department.
  • Provide appropriate head injury advice to a person and/or their family/carers who does not require immediate hospital referral.
  • Follow up a person with ongoing symptoms following head injury, and refer to an appropriate specialist if needed.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

The following National Institute for Health and Care Excellence (NICE) audit criteria are relevant for primary care.

  • People who have sustained a head injury should be referred to a hospital emergency department, using the ambulance service if deemed necessary, if any of the following are present as a result of the injury:
    • Glasgow Coma Scale (GCS) score of less than 15 on initial assessment.
    • Any loss of consciousness.
    • Any focal neurological deficit.
    • Any suspicion of a skull fracture or penetrating head injury.
    • Amnesia for events before or after the injury.
    • Persistent headache.
    • Any vomiting episodes.
    • Any seizure.
    • Any previous brain surgery.
    • A high-energy head injury.
    • Any history of bleeding or clotting disorders.
    • Current anticoagulant or antiplatelet (except aspirin monotherapy) treatment such as warfarin.
    • Current drug or alcohol intoxication.
    • Any safeguarding concerns, such as possible non-accidental head injury or the injured person is vulnerable.
    • Continuing concern by the professional about the diagnosis.
  • Injured people should be accompanied by a competent adult during transport to the emergency department, and the referring professional should inform the destination hospital (by phone) of the impending transfer. In non-emergencies, a letter summarising signs and symptoms should be sent with the person.
  • Transport patients who have sustained a head injury directly to a hospital that has the age-appropriate resources to further resuscitate them and to investigate and initially manage multiple injuries.

[NICE, 2023a]

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Head injury

  • People attending an emergency department with a head injury have a CT head scan within 1 hour of a risk factor for brain injury being identified.
  • People attending an emergency department with a head injury have a CT cervical spine scan within 1 hour of a risk factor for spinal injury being identified.
  • People attending an emergency department with a head injury have a provisional written radiology report within 1 hour if a CT head or cervical spine scan is performed.
  • People with a head injury who have a Glasgow Coma Scale (GCS) score of 8 or lower at any time have access to specialist treatment from a neuroscience unit.
  • Community-based neurorehabilitation services provide a range of interventions to help support people with continuing cognitive, communicative, emotional, behavioural, or physical difficulties as a result of a traumatic brain injury.

[NICE, 2025a]

Background information

Definition

  • Head injury is defined as any trauma to the head other than superficial injuries to the face, and includes both closed head and penetrating injuries.
    • Traumatic brain injury results from an external force which causes a disturbance of normal brain function or produces other evidence of brain pathology.
    • Not all head injuries lead to traumatic brain injury.
  • Traumatic brain injury can be categorized as mild (also known as concussion), moderate, or severe.

[CDC, 2018; Mason, 2019; NICE, 2023b; NINDS, 2026] 

Causes

  • Among children under 2 years hospitalized with a head injury, it is estimated that abuse is the cause of head injury in 25–30%.
  • In younger adults, head injuries usually result from high-energy impacts such as motor vehicle accidents or falling from a height.
  • Many people, particularly older adults, those aged 65 years and older, are injured through low-level falls, which can be sustained in the context of acute illness or related to multimorbidity, frailty, and polypharmacy.
  • Other prevalent causes of head injury include assaults, sports injuries, and military combat.

[NICE, 2023b; Aljboor, 2024; Mavroudis, 2024; de Wit, 2025]

Risk factors

  • Age above 65 years — an increasing proportion of people presenting with head injury are over 65 years old. This may be related to older adults experiencing a decrease in the elastic integrity of the cerebral bridging veins and brain atrophy, allowing rapid movements of the brain with trauma, whilst also having a higher risk of frailty-related traumatic falls.
  • Male sex — it is estimated that males are 1.5 times more likely than females to be admitted to a hospital in the UK for a head injury.
  • Contact sports.
  • Drug or alcohol use.
  • Military service.

[NICE, 2023b; Patricios, 2023; Aljboor, 2024; Mavroudis, 2024; Headway, 2024; de Wit, 2025]

Incidence

The incidence of head injury is difficult to assess as it varies according to the study definitions used and the point in the care pathway where people with head injury are assessed. Estimates indicate:

  • More than 1 million people attend emergency departments in England and Wales each year with a recent head injury; 33–50% of these are children aged under 15 years.
  • It is estimated that about 90% of people attending emergency departments with a head injury have a minor head injury.
  • Approximately 200,000 people are admitted to hospital each year following head injury, with approximately 40,000 having evidence of traumatic brain injury.
    • A UK prospective survey of case notes of children aged less than 15 years who were admitted to hospital (n = 5700) found that the peak prevalence of hospital admission for head injury was in infants (those under 1 year old; 19.2% of admissions) [Trefan, 2016].

[Trefan, 2016; NICE, 2023b]

Complications

  • In the UK head injury is the commonest cause of death and disability in people aged 1–40 years.
    • About 0.2% of all people attending emergency departments with a head injury die as a result. Approximately 5% of head injury-related attendances are in people who present with a moderately or severely impaired consciousness level, among whom the majority of the head injury-related deaths occur.
    • A UK prospective survey of case notes of children aged less than 15 years who were admitted to hospital with head injury (n = 5700) reported a mortality rate of 0.4% (predominantly as a result of motor vehicle accident or abusive head trauma) [Trefan, 2016].
  • Head injury may result in many neurological deficits, such as problems with gait, mobility, muscle weakness, spasticity, contractures, and communication and swallowing problems (for example, dysarthria, dysphasia, and other difficulties in the use of language).
  • Other complications of head injury include:
    • Intracranial lesions such as extradural or subdural haematoma, subarachnoid haemorrhage, cerebral contusion, or intracerebral haematoma.
      • The risk of intracranial haemorrhage is increased in people taking anticoagulant medication.
    • Skull fracture.
    • Post-traumatic seizures.
    • Hypopituitarism (particularly following moderate or severe brain injury). 
      • Hypopituitarism is estimated to occur in 33–50% of all people following traumatic brain injury, and may be caused by haemorrhage, raised intracranial pressure, neuroinflammatory responses, oedema, skull fracture, or direct insult to the pituitary gland.
      • The prevalence of hypopituitarism appears to be highest in the three months post-injury and gradually decreases over time, suggesting an initial surge in pituitary dysfunction post-injury, although prevalence remains elevated in the chronic phase.
      • Symptoms are often non-specific and overlap with post-concussion symptoms. Rare life-threatening complications include sodium dysregulation and adrenal crisis.
    • Mild traumatic brain injury (also known as concussion) — transient disturbance in the function of the brain caused by head injury.
      • Commonly reported symptoms include headache, dizziness, difficulty concentrating, and confusion.
      • The incidence of concussion in professional rugby union has been reported to range between 15–20 concussions per 1000 player-match-hours.
      • Continuing to play a contact sport with concussion increases the risk of further head or non-head injury, worsened severity, and delayed recovery.
    • Depression and anxiety.
      • Mood disorders are a common complication of head injury.
      • One cohort study (n = 559) found that in the year following head injury 53.1% of people met the criteria for depression. Prevalence of depression was eight times that of the general population [Bombardier et al, 2010].
      • A meta-analysis (41 studies) of the prevalence of generalized anxiety disorder (GAD) in adults following non-penetrating traumatic brain injury found that 11% of people were diagnosed with GAD (range 2–28%) — the highest prevalence occurred 2–5 years post-injury [Osborn, 2016].
    • Post-traumatic stress disorder (PTSD).
      • An observational study (n = 96) found that 27.1% of people with a severe traumatic brain injury developed PTSD 6 months after the initial injury [Bryant et al, 2000].
      • PTSD can occur after severe head injury even if there is no recollection after the traumatic event (if the person has extended post-traumatic amnesia).
    • Cognitive impairment and challenging behaviour.
      • Cognitive impairment may include problems with memory, attention and concentration, planning, problem solving, language, and perception.
      • Challenging behaviour may include inappropriate vocalization, disinhibited or sexualized behaviour.
    • Neurodegenerative disease.
      • Moderate-to-severe or repetitive traumatic brain injuries have been related to an increased risk of developing conditions such as dementia and Alzheimer's disease.
      • Repetitive traumatic brain injury, particularly in athletes and military personnel, has been linked with chronic traumatic encephalopathy (CTE), a condition characterized by cognitive and behavioural changes similar to those seen in people with dementia.
      • The mechanisms behind these associations are yet to be determined, but hypotheses include accelerated aging, increased amyloid protein deposition, and chronic neuroinflammation leading to neurodegeneration.

[SIGN, 2013; Firsching, 2017; CDC, 2018; Mason, 2019; Fuller, 2020; Kernick, 2020; Silverberg, 2020; Howlett, 2022; NICE, 2023b; Aljboor, 2024; Mavroudis, 2024; de Wit, 2025]

Prognosis

  • The majority of people with minor head injury recover fully without specific or specialist intervention.
  • The incidence of death as a result of head injury is low (approximately 0.2% of all people attending emergency departments with a head injury).
    • The majority of fatal outcomes are in people with moderate (GCS 9–12) or severe (GCS 8 or less) head injury.
    • Mortality risk is estimated to be 15–20% among older adults (people aged 65 or older) who sustain an intracranial haemorrhage from a ground-level fall. However, the prognosis varies by haemorrhage type, with subdural bleeding mortality risk being estimated at 20–70%, whereas mortality risk following isolated traumatic subarachnoid bleeding is estimated to be less than 1%.
  • Most people with persistent symptoms of mild traumatic brain injury recover within 2–3 months of the injury.
    • Delayed presentation of intracranial complications is rare after mild traumatic brain injury, and usually occurs within 24 hours of the injury.
    • Deterioration in clinical state 21 days after a head injury is very rare (approximately 0.1% of cases).
    • Around 1 in 1000 people with traumatic brain injury have difficulties that persist beyond 1 year after the injury.
  • Factors that may increase the risk of a poor prognosis following mild traumatic brain injury include:
    • Female sex.
    • Age over 40 years.
    • Persistent physical illness and/or a pre-existing neurological condition.
    • Previous head injuries.
    • Comorbid mental health problems, such as anxiety and depression.
    • Lack of social support.
  • In sports-related concussion:
    • Adults will typically recover within two weeks, while most children will recover in 4 weeks.
    • Although most people will recover in these time frames, between 15% and 50% may take over a month to recover.

[Mott, 2012; SIGN, 2013; CDC, 2018; NICE, 2023b; Putukian, 2023; de Wit, 2025]

Management

Scenario: Head injury

From birth onwards.

How should I assess a person with a head injury?

  • The initial aim of assessment is to rapidly identify indications for emergency transfer to hospital.
  • Take a history to identify:
    • How and when the head injury occurred.
    • The mechanism of injury — a dangerous mechanism of injury includes any high-energy mechanism such as:
      • Fall from a height of greater than 1 metre or 5 stairs.
      • High-speed motor vehicle collision either as a pedestrian, cyclist, or vehicle occupant.
      • Rollover motor accident or ejection from a motor vehicle.
      • Accident involving motorized recreational vehicles or bicycle collision.
      • Diving accident.
    • Current symptoms since the injury, such as:
      • Loss of consciousness.
      • Confusion.
      • Amnesia.
      • Seizure.
      • Vomiting (including number of episodes).
      • Headache.
      • Neck pain.
      • Diplopia or other visual disturbance.
    • Recent alcohol or drug intake.
    • Current anticoagulant medication.
    • Past medical history including pre-injury level of functioning, bleeding disorders, surgery, and previous head trauma.
  • Examine the person to assess:
    • Level of consciousness using the Glasgow Coma Scale.
    • Vital signs — look for hypoxia or signs of shock (such as tachycardia, hypotension, or reduced capillary refill time).
    • Signs of visible trauma to the scalp, skull, head, and neck.
    • Cranial nerves including pupil size and reactivity.
      • Fundoscopy may identify retinal haemorrhage or papilloedema.
    • Signs of focal neurological deficit, such as:
      • Problems with visual or speech disturbance, understanding speech, reading or writing.
      • Problems with balance or walking.
      • Loss of muscle power.
      • Paraesthesia in the upper or lower limbs or abnormal reflexes.
    • Signs of basal skull fracture, which may present with:
      • Clear fluid (possible cerebrospinal fluid) leaking from the ear(s) or nose.
      • Periorbital haematoma(s) with no associated damage around the eyes.
      • Bleeding from one or both ears; blood behind the eardrum (haemotympanum); new deafness in one or both ears.
      • Battle's sign — bruising behind one or both ears over the mastoid process, suggesting fracture of the middle cranial fossa.
    • Neck tenderness — midline cervical spine tenderness may indicate cervical spine injury.
      • If head injury presents with risk factors for cervical spinal injury full cervical spine immobilization should be attempted (and maintained until a full risk assessment, including imaging where necessary, indicates it is safe to remove the immobilization device).
    • Range of neck movements — an inability to rotate the neck 45 degrees to the left and right may indicate cervical spine injury. Safe examination of the neck should only be performed using clinical judgement if the person:
      • Was involved in a simple rear-end motor vehicle collision.
      • Is comfortable in a sitting position.
      • Has been ambulatory at any time since the injury.
      • Has no midline cervical spine tenderness.
      • Presents with delayed onset neck pain.
  • Be alert for the possibility of non-accidental injury as a contributory factor or cause of head injury.
    • Safeguarding concerns may be raised where there is a delay in presentation, where the history of the injury is inconsistent or does not fit with the age or developmental stage of the child (such as bruising or laceration in a child who is not independently mobile). 
    • For more information, see the CKS topics on Child maltreatment - recognition and management, Domestic violence and abuse, and Self harm.
    • If any safeguarding concerns are identified, document these and follow local safeguarding procedures appropriate to the patient's age.

The Glasgow Coma Scale

The Glasgow Coma Scale (GCS) is used internationally in clinical practice to assess the depth and duration of impaired consciousness and coma.

  • GCS is used to assess the level of consciousness in all people who have received a head injury (including people who appear intoxicated).
    • People are scored on three different aspects of behavioural response: eye opening, verbal, and motor responses. Each response is evaluated independently of the other and graded, with the lowest possible score being 3 (deep coma or death), and the highest being 15 (fully awake).
    • For example, a person with a best score of 4 for eye response, 5 for verbal response, and 5 for motor response should be recorded as E4, V5, M5 and the total cumulative score of 14/15 given.
    • People with dementia, chronic neurological disorders, or learning difficulties, for example, may have a pre-injury baseline GCS score of less than 15, which should be taken into account during clinical assessment.
  • GCS scores indicate the severity of traumatic brain injury:
    • GCS score of 13–15 — mild traumatic brain injury.
    • GCS score of 9–12 — moderate traumatic brain injury.
    • GCS score of 8 or less — severe traumatic brain injury.

Glasgow Coma Scale for adults.

  • Best eye response:
    • Opens eyes spontaneously — score 4.
    • Opens eyes in response to voice — score 3.
    • Opens eyes in response to pressure (after finger-tip stimulus) — score 2.
    • Does not open eyes — score 1.
  • Best verbal response:
    • Orientated and converses normally — score 5.
    • Confused and disorientated — score 4.
    • Inappropriate words — score 3.
    • Incomprehensible sounds — score 2.
    • Makes no sounds — score 1.
  • Best motor response:
    • Obeys simple commands — score 6.
    • Localizes to stimulus  — score 5.
    • Flexion or withdrawal in response to painful stimuli — score 4.
    • Abnormal flexion in response to painful stimuli — score 3.
    • Extension in response to painful stimuli — score 2.
    • Makes no movement in response to pain — score 1.

Glasgow Coma Scale for children and infants.

  • Best eye response:
    • Eyes open spontaneously — score 4.
    • Eyes open in response to voice — score 3.
    • Eyes open in response to painful stimuli — score 2.
    • No eye opening — score 1.
  • Best verbal response:
    • Child
      • Smiles and orients to sounds, follows objects, and interacts — score 5.
      • Confused and disorientated — score 4.
      • Inappropriate words — score 3.
      • Incomprehensible sounds — score 2.
      • No vocal response — score 1.
    • Pre-verbal infant
      • Coos and babbles (verbal to usual ability)— score 5.
      • Irritable cries and less verbal than usual ability — score 4.
      • Cries to pain — score 3.
      • Moans to pain — score 2.
      • No response — score 1.
  • Best motor response:
    • Spontaneous purposeful movement or obeys simple commands — score 6.
    • Localizing touch— score 5.
    • Withdrawal from pain — score 4.
    • Flexion in response to pain — score 3.
    • Extension in response to pain —score 2.
    • No motor response — score 1.

[NHS Greater Glasgow and Clyde, 2015; NICE, 2023b; NHS Healthier Together Programme, 2024; RCEM, 2026]

Basis for recommendation

The recommendations on how to assess a person with a head injury are based on the clinical guidelines Head injury: assessment and early management [NICE, 2023b], Child maltreatment: when to suspect maltreatment in under 18s [NICE, 2025b], Guidelines for the treatment of head injury in adults [Firsching, 2017], and Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children [CDC, 2018]; expert opinion in review articles [Halstead, 2018; Kernick, 2020; Silverberg, 2020]; and the Head injury pathway: clinical assessment and management tool for children [NHS Healthier Together Programme, 2024].

Non-accidental injury
  • The recommendation on being alert for non-accidental injury is based on the NICE clinical guideline Child maltreatment: when to suspect maltreatment in under 18s [NICE, 2023b] and the Head injury pathway: clinical assessment and management tool for children [NHS Healthier Together Programme, 2024].
  • It is estimated that 25–30% of children aged under 2 years who are hospitalized with a head injury have a non-accidental injury [NICE, 2023b].

How should I initially manage a person with a head injury?

  • The initial aim of assessment is to rapidly identify patients who need emergency transfer to hospital.
    • Basic and advanced adult or paediatric trauma life support protocols should be followed with appropriate interventions as indicated.
    • Full cervical spine immobilization should be attempted for people who have sustained a head injury and have any risk factors for cervical spinal injury, for example:
      • Glasgow Coma Scale (GCS) less than 15 on initial assessment.
      • Neck pain or tenderness.
      • Focal neurological deficit.
      • Paraesthesia in the extremities.
  • Arrange immediate transfer to the hospital emergency department (accompanied by a competent adult) if any of the following risk factors for intracranial complications or cervical spine injury are present: 
    • GCS score of less than 15 on initial assessment.
    • Evidence of shock, or other injuries suggesting chest or abdominal trauma, limb or pelvic trauma, or significant vascular injury.
    • Dangerous mechanism of injury or high-energy head injury (such as a high-speed road traffic accident or a fall from a height of more than 1–3 metres, dependent on the person's age and/or height).
    • A history of bleeding or coagulation disorders, current anticoagulant or antiplatelet (except aspirin monotherapy) medication.
    • Current alcohol or drug intoxication.
    • Any loss of consciousness after the injury (even if they are fully alert on presentation).
    • Any post-traumatic seizure.
    • Any previous brain surgery.
    • Amnesia for events before or after the injury.
      • Assessment of amnesia is unlikely to be possible in a child aged under 5 years.
    • Persistent or worsening headache since the injury.
    • Any vomiting since the injury.
      • Clinical judgement should be used in children under the age of 12 regarding the cause of vomiting and the need for referral.
    • Any focal neurological deficit since the injury. 
    • A suspected open or depressed skull fracture, or tense fontanelle in a child.
    • A suspected basal skull fracture.
    • Signs of a penetrating injury or visible trauma to the scalp or skull.
      • In children under 1 year of age, a bruise, swelling, or laceration of more than 5 cm on the head.
    • Suspected cervical spine injury following assessment of the neck.
    • Irritability or altered behaviour, particularly in infants and children aged under 5 years.
    • Clinical concern about the diagnosis of head injury.
    • Ongoing concern by the person or their family/carers.
    • A responsible adult is unable to stay with the person for the first 24 hours after the injury.
  • Refer an adult or child immediately to the hospital emergency department (accompanied by a competent adult) if there is:
  • For all other children and adults who are at low risk of an intracranial complication or cervical spine injury:
    • Advise that a responsible adult should stay with the person for the first 24 hours after the injury and remain alert for worrying signs and symptoms which indicate the need for urgent medical review. These may include:
      • Focal neurological deficits — difficulties with understanding, speaking, reading or writing, decreased sensation, loss of balance, weakness, visual changes, nystagmus, abnormal reflexes, problems walking, or amnesia since the injury.
      • Indication of a complex skull fracture — clear fluid running from the ears or nose, black eye(s) with no associated injury around the eyes, bleeding from one or both ears, or bruising behind one or both ears.
      • Non-specific symptoms — persistent headaches, vomiting, irritability or altered behaviour.
    • Give the person and/or family/carers verbal and written information and self-care advice.
    • Be aware of specific guidelines for timing of return to play in sports-related head injury – see the section on information and self-care advice for further detail.

Basis for recommendation

The recommendations on how to initially manage a person with a head injury and the risk factors for a serious complication are based on the National Institute for Health and Care Excellence (NICE) clinical guidelines Head injury: assessment and early management [NICE, 2023b], Spinal injury: assessment and initial management [NICE, 2016a] and Major trauma: assessment and initial management [NICE, 2016b], the NICE Quality Standard Head injury QS 74 [NICE, 2025a], the Australian and New Zealand Resuscitation Council (ANZCOR) guidelines on First aid management of head injury [ANZCOR, 2025], the Centres for Disease Control and Prevention (CDC) guideline Diagnosis and management of mild traumatic brain injury among children [CDC, 2018], expert opinion in review articles [Firsching, 2017; Halstead, 2018; Kernick, 2020; Song, 2024; de Wit, 2025], and the Head injury pathway: clinical assessment and management tool for children [NHS Healthier Together Programme, 2024].

Risk factors for intracranial complications or cervical spine injury
  • The risk of long-term complications of head injury may be increased if definitive treatment is delayed at presentation — immediate transfer to the emergency department for further assessment (including urgent imaging) where risk factors for complications are present is essential [Nishijima, 2012; Firsching, 2017; NICE, 2023b; NICE, 2025a].
  • NICE recommend that patients referred from community health services should be accompanied by a competent adult during transport to the emergency department. The referring professional should inform the destination hospital (by phone) of the impending transfer [NICE, 2023b; NICE, 2025a].
  • Patients with risk factors for intracranial complication or cervical spine injury should be transported to a hospital that has age appropriate resources for further resuscitation, investigation, and initial management of multiple injuries [NICE, 2023b; NICE, 2025a].
Emergency transfer to hospital
  • Indications for emergency transfer to hospital are from the NICE clinical guideline Head injury: assessment and early management[NICE, 2023b], the Head injury pathway: clinical assessment and management tool for children [NHS Healthier Together Programme, 2024], and the Australian and New Zealand Resuscitation Council (ANZCOR) guidelines on First aid management of head injury [ANZCOR, 2025].
  • Recommendations on cervical spine immobilization are based on the NICE guideline Spinal injury: assessment and initial management [NICE, 2016a].
  • Adults and children who are on any anticoagulant (including vitamin K antagonists, direct-acting oral anticoagulants [DOACs], heparin and low molecular weight heparins) or antiplatelet (except aspirin monotherapy) may require a CT head scan within 8 hours of head injury, or within one hour if presentation is delayed for more than 8 hours post-injury [NICE, 2023b].
  • Depressed conscious level should only be ascribed to intoxication only after a significant brain injury has been excluded [NICE, 2023b].
  • The recommendation to assess vomiting since the injury using clinical judgement, reflects the high incidence of a single vomit in younger children (those 12 years old or under) with a head injury which alone is not necessarily a cause for concern [NICE, 2023b].
  • The Australian and New Zealand Resuscitation Council highlights that clinicians should be aware that a person may have sustained a significant head injury without any loss of consciousness or amnesia, or any external signs of injury [ANZCOR, 2025].

How should I follow up a person with persistent symptoms?

  • Re-assess all people with ongoing symptoms or signs after a mild traumatic head injury.
    • Refer the person immediately to the hospital emergency department (accompanied by a competent adult) if:
      • They have persistent or worsening clinical features relating to the initial head injury, such as vomiting or headaches, or new-onset focal neurological signs which may indicate a possible complication.
    • Discuss with/refer the person to neurology or neuroendocrinology, neuropsychology or psychiatry, neurosurgery, or a specialist in rehabilitation medicine, depending on clinical judgement if:
      • There are persistent non-specific symptoms for more than 3 months after head injury suggesting possible post-concussion syndrome.
      • There are concerns or uncertainty about the nature or severity of symptoms.
    • Consider investigations or endocrinology referral for people with persistent symptoms consistent with hypopituitarism following a head injury.
      • Any severity of head injury can cause pituitary dysfunction, which may present immediately, hours, weeks or months after the injury.
    • Consider other possible causes of symptoms and investigate as appropriate.
  • If there are no features of a possible complication and other causes of symptoms have been excluded:
  • For people with a suspected or confirmed chronic neurological disorder following a brain injury:
    • Ensure that the need for rehabilitation has been identified and discussed with their specialist.
    • Discuss with the person and/or their family or carer that their prognosis and rehabilitation needs may emerge or change over time.
    • Undertake regular follow-up of the person to assess for changes in their symptoms or level of functioning, and whether their rehabilitation needs have altered and are being met.
    • Ensure the person and/or their family or carer have access to appropriate sources of support, information, and self-care advice.
    • When required (for example, where a specialist has not previously initiated referral or where new rehabilitation needs emerge), consider referral to an appropriate specialist or specialist in rehabilitation medicine, whilst briefly assessing the person's:
      • Social, psychological, emotional, cognitive and communication needs.
      • Physical health.
      • Level of impairment.
      • Impact of their condition on day-to-day activities.

Basis for recommendation

The recommendations on how to follow up a person with a head injury with ongoing symptoms and signs are based on the Scottish Intercollegiate Guideline Networks (SIGN) clinical guidelines Brain injury rehabilitation in adults [SIGN, 2013], the National Institute for Health and Care Excellence (NICE) clinical guidelines Head injury: assessment and early management [NICE, 2023b] and Rehabilitation for chronic neurological disorders including acquired brain injury [NICE, 2025c], The 2022 International Consensus Statement on Concussion in Sports [Patricios, 2023], and expert opinion in review articles [Mott, 2012; Kernick, 2020; Silverberg, 2020; Howlett, 2022; Aljboor, 2024].

Emergency referral to hospital if persistent symptoms
  • The recommendation to refer people with worsening symptoms following a head injury (which may suggest a complication) to the emergency department is based on expert opinion in a review article [Silverberg, 2020].
  • The SIGN guideline on brain injury rehabilitation states that delayed presentation of intracranial pathology is rare after mild traumatic brain injury, and usually occurs within 24 hours of the injury. A deterioration in clinical state 21 days after a head injury is very rare, occurring in only 0.1% of cases [SIGN, 2013].
Referral for specialist assessment
  • People with a head injury may require investigation into the original cause of the injury, to manage contributing factors, or to manage persisting problems, such as physical, sensory, motor, cognitive, emotional or hormonal (hypopituitarism) complications (which can occur even in people who are not admitted to hospital or have normal imaging at the time of their injury) [NICE, 2023b].
  • The NICE guideline recommends referring people with a head injury to investigate its causes and manage contributing factors, where appropriate, such as to a falls assessment or to safeguarding service. NICE also recommend considering referral for people with persistent problems following traumatic brain injury, such as to a neurologist, neuropsychologist, clinical psychologist, neurosurgeon or endocrinologist, or a multidisciplinary neurorehabilitation team [NICE, 2023b].
  • The SIGN guideline on brain injury rehabilitation recommends referral to a multidisciplinary neuropsychological rehabilitation programme for people with ongoing symptoms to address any cognitive, emotional, and behavioural difficulties [SIGN, 2013].
  • The recommendation to consider the need for referral to neuroendocrinology is based on NICE guidance and expert opinion in a review article, to exclude complications of head injury such as hypopituitarism, which can present with non-specific symptoms [NICE, 2023b; Aljboor, 2024].
  • The SIGN guideline notes that in a minority of people, head injury may be the result of a developing neurological condition, such as a brain tumour, which may cause loss of balance and predispose a person to falls. If there are persistent or new-onset focal neurological signs, for example, specialist referral to neurology should be arranged [SIGN, 2013].
  • The recommendations on the follow-up and referral of people with a suspected or confirmed chronic neurological disorder are based on the NICE guideline Rehabilitation for chronic neurological disorders including acquired brain injury [NICE, 2025c].
Hypopituitarism
  • The NICE guideline recommends considering further endocrinology investigations for people who have been discharged after a head injury if they have persistent symptoms consistent with hypopituitarism or are not recovering as expected [NICE, 2023b].
  • The mechanism of why hypopituitarism occurs following a head injury is unknown. There is a higher risk of hypopituitarism with more severe head injuries, but it can also be caused by a mild head injury and may occur immediately after a head injury or in the weeks to months afterwards [NICE, 2023b].
  • Hypopituitarism occurs due to a reduction in hormones produced by the pituitary gland, including growth hormone, gonadotrophins (luteinizing hormone or follicle stimulating hormone), thyroid stimulating hormone, prolactin and adrenocorticotrophic hormone), and arginine vasopressin [NICE, 2023b].
  • Underactivity of the pituitary gland can lead to [NICE, 2023b]:
    • Weakness, fatigue, weight loss, hypotension, hyponatraemia, hypoglycaemia, hypercalcaemia, anaemia and fatigue, due to adrenocorticotropic hormone deficiency. 
    • Decreased energy, low mood, neuropsychiatric and cognitive symptoms, decreased lean body mass, increased fat mass, altered metabolic profile and decreased exercise capacity, due to growth hormone deficiency.
    • Delayed puberty, hot flushes, fatigue, tiredness, loss of body hair, reduced sex drive, irregular periods, erectile dysfunction and reduced fertility, due to sex hormone deficiency.
    • Slow growth, fatigue, lethargy, cold intolerance and weight gain, due to thyroid-stimulating hormone deficiency.
    • Polyuria, polydipsia, nocturia and incontinence, due to vasopressin deficiency. 
Management of persistent non-specific symptoms
  • The 2022 International Consensus Statement on Concussion in Sports advises that the term ‘persisting symptoms’ is used for symptoms that persist >4 weeks across children, adolescents and adults [Patricios, 2023].
    • Persistent symptoms which can be attributed to concussion are non-specific, commonly reported by healthy individuals and those with conditions other than concussion, and can also be exacerbated by a variety of concurrent factors.
    • Health problems may also exist prior to a head injury, which may be exacerbated by concussion or mimic persisting symptoms.
    • Common co-occurring health problems which may require consideration when assessing persisting conditions include mental health issues; learning or attention difficulties; visual, oculo-motor, cervical and vestibular problems; headache disorders and migraine; sleep disturbance; dysautonomia, including orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS); and pain.
  • The SIGN guideline on brain injury rehabilitation recommends that uncomplicated symptoms should be treated the same as for the general population without a history of head injury [SIGN, 2013]. Other causes of symptoms should be considered and investigated as appropriate [SIGN, 2013; Silverberg, 2020].
  • The recommendation to offer reassurance and advice to people with persistent non-specific symptoms is based on the SIGN guideline on brain injury rehabilitation [SIGN, 2013] and expert opinion in review articles on mild traumatic brain injury [Mott, 2012; Silverberg, 2020].
    • Early education about the diagnosis and symptoms of head injury and expected prognosis, can help to create realistic expectations, reduce anxiety, and help normalize symptoms [Mott, 2012].
    • This is supported by evidence from a placebo-controlled trial (n = 218) that showed that intervention in the form of reassurance and education given within the first few weeks of minor head injury significantly improved post-concussion symptoms, resulting in significantly less social disability (p = 0.01) and less severe post-concussion symptoms (p = 0.02) at follow up 6 months after injury in the active intervention group [Wade, 1998].
    • For people with prolonged symptoms following mild traumatic brain injury, personal and social factors may be contributing factors [SIGN, 2013].
  • A gradual return to normal activities is recommended in a review article on subacute to chronic mild traumatic brain injury — for people with persistent symptoms, it is important to address any comorbidities or secondary problems that may complicate a person's recovery, such as stress, depression, or chronic pain [Mott, 2012].
  • Mood symptoms are common after traumatic brain injury [Silverberg, 2020; Howlett, 2022].
    • SIGN highlight the need for assessment of anxiety, low mood, and flashbacks and nightmares if problems following a head injury persist for more than 3 months. Referral for cognitive behavioural therapy (CBT) following mild traumatic brain injury may be appropriate [SIGN, 2013].

What information and self-care advice should I give?

  • Give verbal and written information and self-care advice to the person and/or family/carers following a head injury, including:
    • Details of the nature and severity of the injury.
    • The need for a responsible adult to stay with the person for the first 24 hours after their injury.
    • Details of the expected recovery process, warning signs of more serious injury, and when to immediately attend the hospital emergency department or seek urgent medical advice.
      • It is important to highlight that some people may appear to make a quick recovery, but can experience delayed difficulties or complications.
    • Information about return to everyday activities, including school, work, sports, and driving.
      • People should not return to competition, training or Physical Education (PE) lessons within 24 hours of a suspected concussion, and there should be no return to full competition before 21 days from injury in people with a confirmed concussion.
      • Anyone with a suspected concussion should not drive a motor vehicle, ride a bicycle, operate machinery, or drink alcohol within 24 hours of a suspected concussion.
      • Be aware of specific guidelines for timing of return to play in sports-related concussion — early return to full sporting activity increases the risk of more severe injury and prolonged recovery. Further information is available from England Rugby and the Football Association.
      • Where sport-specific guidelines do not exist, recommendations on the return to education/work and sports activities are provided by the UK Concussion Guidelines for Non-Elite (Grassroots) Sport.
        • Briefly, after 24–48 hours of relative rest, people with a sports-related concussion should follow a gradual return-to-sport programme, progressing from light and moderate aerobic activity to sport-specific exercise (no risk of head contact), non-contact training, full-contact practice and return to competition.
        • In this graduated approach, advancement through the steps is guided by symptomology, where more than a mild exacerbation should interrupt the activity and the person should return to attempt the exercise the next day.
      • The Driver and Vehicle Licensing Agency (DVLA) document Assessing fitness to drive - a guide for medical professionals has information on whether a person is fit to drive following a head injury.
      • Regarding a return to school or work, it is expected that almost all people with a sports-related concussion will make a full recovery by 10 days post-injury. After 24–48 hours of relative rest (minimizing screen time), people with a sports-related concussion should begin a gradual and incremental increase in their cognitive load, with progression slowed when any more than a mild or brief symptom exacerbation occurs.
  • Sources of patient information and support include:
    • The NHS A to Z of health Concussion.
    • The NHS Healthier together website Head Injury: advice for parents and carers of children.
    • Headway – The Brain Injury Association Mild head injury and concussion.
      • Headway also provides information on sources of local support for people with brain injury and assists people with brain injuries to return to community living.
    • Brain and Spine Foundation Head Injury.
    • Child Brain Injury Trust Concussion.  
      • The Child Brain Injury Trust provides emotional and practical support for families and professionals affected by childhood acquired brain injury. A wide variety of factsheets about acquired brain injury are available.

Basis for recommendation

This information is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Head injury: assessment and early management [NICE, 2023b], the Centres for Disease Control and Prevention (CDC) guideline Diagnosis and management of mild traumatic brain injury among children [CDC, 2018], the 2022 International Consensus Statement on Concussion in Sports [Patricios, 2023], UK Government guidance Concussion Guidelines for Non-Elite (Grassroots) Sport [DCMS, 2024], and expert opinion in review articles [Mott, 2012; Halstead, 2018; Silverberg, 2020; De Luigi, 2023; Putukian, 2023].

Expected prognosis
  • Early education about the diagnosis and symptoms of head injury and expected prognosis, can help to create realistic expectations, reduce anxiety, and help normalize symptoms [Mott, 2012].
Return to sport
  • Return to contact or high-risk activities should only occur after symptoms of concussion have completely resolved and a return-to-sport protocol has been completed [Halstead, 2018].
  • The 2022 International Consensus Statement on Concussion in Sports and UK Government guidance recommends a return to sport strategy for individuals who have experienced a sports related concussion [Patricios, 2023; DCMS, 2024]:
    • The first 24 to 48 hours post-injury should involve a period of relative rest (undertaking daily activities which do not exacerbate any symptoms of concussion). Following which, light (up to 55% of maximum heart rate) and then moderate (up to 70% of maximum heart rate) aerobic activity, can be undertaken as a  treatment of acute concussion.
    • Gradual return to sporting activity can then be undertaken, with the time course for progression through each of the following steps determined by symptoms, cognitive function, examination findings and clinical judgement:
      • Return to sport-specific training exercises, where no activities pose a risk of head impact.
      • Return to non-contact training exercise at full intensity.
      • Return to full contact training exercise, with resumption of normal training activities.
      • Return to normal game play.
    • In this graduated approach, advancement through the steps should be guided by symptoms, where more than a mild exacerbation should interrupt the activity, and the person should return to attempt the exercise the next day.
    • This strategy can be completed in a minimum of 1 week, but typical unrestricted return to sport can take up to one month post-injury.
  • A systematic review found sufficient evidence to recommend exercise as an appropriate therapy for adolescents with acute concussion or a mild traumatic brain injury, and also found evidence indicating detrimental effects from strict rest (including combined cognitive and physical rest) and high-intensity physical activity [De Luigi, 2023].
Return to learning strategy
  • Recommendations relating to returning to work and learning following a sports-related concussion are based on the 2022 International Consensus Statement on Concussion in Sports [Patricios, 2023], UK Government guidance [DCMS, 2024], and expert opinion in review articles [De Luigi, 2023; Putukian, 2023].
  • It is expected that 93% of those with a sports related concussion will be able to make a full return to learning (participating in preinjury learning activities with no new academic support) by 10 days post sports related concussion [Patricios, 2023].
    • Academic support may be required by 13-56% of those with a sports related concussion, and females may be more likely to report academic dysfunction [Putukian, 2023].
    • Temporary academic support may include environmental adjustments (such as no or modified school attendance, frequent rest breaks and limited screen time on devices), physical adjustments, (such as, avoid activities at risk of contact, collision or falls), curriculum adjustments (such as, extra time to complete or reduce assignments/homework) and testing adjustments (such as, exemption from, delaying and/or permitting additional time for examinations/tests) [Putukian, 2023].
  • Healthcare providers should avoid recommending complete rest and isolation, even for the initial 24–48 hours, and instead recommend a period of relative rest, encouragement of early return to activities of daily living (provided symptoms are no more than mildly increased) [Patricios, 2023]. There is emerging evidence that prolonged strict rest delays return to learning [Putukian, 2023].
  • The 2022 International Consensus Statement on Concussion in Sports recommends and UK Government guidance recommends a return to sport strategy for individuals who have experienced a sports related concussion [Patricios, 2023; DCMS, 2024]:
    • Facilitating return to learning is a vital part of the recovery process for people who have experienced a sports related concussion.
    • If symptom exacerbation occurs during cognitive activity or screen time, difficulties with reading, concentration or memory or other aspects of learning, students should begin a gradual and incremental increase in their cognitive load:
      • Daily activities that do not result in more than a mild exacerbation of symptoms of concussion, including minimizing screen time.
      • Undertaking school activities (such as, homework or reading) outside of the classroom.
      • Return to school part time, with gradual introduction of schoolwork (may require a partial school day or greater access to rest breaks).
      • Return to school full time.
    • Progression through the strategy should be slowed when there is more than a mild and brief symptom exacerbation.
  • A systematic review found insufficient evidence to recommend cognitive rest as an appropriate therapy for children, adolescents or adults with acute concussion or a mild traumatic brain injury [De Luigi, 2023].

Supporting evidence

This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Head injury: assessment and early management [NICE, 2023b], the NICE Quality Standard Head injury QS 74 [NICE, 2025a], the Australian and New Zealand Resuscitation Council (ANZCOR) guidelines on First aid management of head injury [ANZCOR, 2025], the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline Brain injury rehabilitation in adults [SIGN, 2013], the Centres for Disease Control and Prevention (CDC) guideline Diagnosis and management of mild traumatic brain injury among children [CDC, 2018], and the Head injury pathway: clinical assessment and management tool for children [NHS Healthier Together Programme, 2024]. The rationale for the individual recommendations is discussed in the relevant basis for recommendation sections.

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews, and randomized controlled trials on primary care management of head injury.

Search dates

April 2021 - July 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp Craniocerebral Trauma/
  • ("head trauma" or "Brain injury" or "traumatic head injury" or "head injury" or "traumatic brain injury") AND (management or prediction or predictor or "decision rule") AND (adult or children or infant or neonate or pediatric or paediatric).mp.

Sources of guidelines

Sources of systematic reviews and meta-analyses

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    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

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The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

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Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

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Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

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Our policy

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Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
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Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
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The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

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  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

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Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Aljboor, G.S., Tulemat, A., Al-Saedi, A.R., et al. (2024) Acute and chronic hypopituitarism following traumatic brain injury: a systematic review and meta-analysis. Neurosurgical review 47(1), 841. [Abstract] [Free Full-text]
  • ANZCOR (2025) Guideline 9.1.4 – First aid management of head injury. Australian and New Zealand Committee on Resuscitation. https://www.anzcor.org [Free Full-text]
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  • CDC (2018) Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. Centres for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/84953
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