Head Injury: Admitted or Observed Patients

The aim of observation and monitoring is to detect neurological deterioration prompting urgent reappraisal.

• Observe the patient every 15 minutes within the first 2 hours. Then 2-hourly thereafter.
• If deterioration, arrange for CT-scanning and monitor every 15 minutes.
• Monitor and record the following:
  • GCS.
  • Pupil size and reactivity.
  • Limb movement.
  • Respiratory rate.
  • Blood pressure.
  • Temperature.
  • Blood oxygen saturation.

Any of the following require prompt re-evaluation:

• Development of agitation or abnormal behaviour
• A sustained (more than 30 min) drop of one point in GCS level
• Any drop of greater than 2 points in GCS level regardless of duration.
• Development of severe or increasing headache or persisting vomiting.
• New or evolving neurological symptoms or signs such as pupil inequality or asymmetry of limb or facial movement.

If any abnormalities are detected, ask a second member of staff to confirm the findings. If confirmed, involve supervising doctor and refer patient to the neurosurgeon.