Head Injury: Discharge of Patients

Discharge plan
Important considerations prior to discharge

Discharge plan

• All patients should be discharged into care of responsible caregiver
• All patients should receive verbal advice and a written head injury advice card before discharge
• Do not discharge any patient who presents with a head injury until
  • GCS = 15 or until they can be cared for by their family
• All patients who have been admitted or undergone imaging should be referred to a community health centre or general practitioner for routine follow-up within one week.

Important considerations prior to discharge

If:

• No carer at home: discharge only if suitable supervision arrangements have been organised, or when the risk of late complications is deemed negligible.
• Low risk, CT not done, GCS = 15: if CT is not indicated on the basis of history and examination, no other factors warrant admission and there are appropriate support structures for safe transfer and subsequent care, the patient may be discharged.
• Normal imaging of the head: if the patient has returned to GCS 15, no other factors warrant admission and there are appropriate support structures for safe transfer and subsequent care, the patient may be discharged.
• Normal imaging of the cervical spine: if the patient has returned to GCS 15, no other factors warrant admission and there are appropriate support structures for safe transfer and subsequent care, the patient may be discharged.
• Admitted for observation: discharge after resolution of all significant symptoms and signs, providing suitable home supervision arrangements exist.
• At risk of non-accidental injury: do not discharge an infant or child with a head injury that required imaging of the head or cervical spine until assessed by a clinician experienced in the detection of non-accidental injury.

Signs that a person who has been discharged within 48 hours from hospital following a head injury should go or be taken to their nearest Emergency Centre:

• Unconsciousness, or lack of full consciousness (for example, problems keeping their eyes open).
• Any confusion (not knowing where they are, getting things muddled up).
• Any drowsiness (feeling sleepy) that goes on for >1 hour when they would normally be wide awake.
• Any problems understanding or speaking.
• Any loss of balance or problems walking.
• Any weakness in one or both arms or legs.
• Any problems with eyesight.
• Very painful headache that won’t go away.
• Any vomiting – being sick.
• Any fits (collapsing or passing out suddenly).
• Clear fluid coming out of the ear or nose.
• New bleeding from one or both ears.
• New deafness in one or both ears.