Quality statement 1: CT head scans | Head injury | Quality standards

Quality statement

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.

Rationale

Head injuries can be fatal or cause permanent disability if damage to the brain is not identified and treated quickly. A CT scan within 1 hour will allow rapid treatment and improve outcomes for people with head injuries that have damaged the brain.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that CT head scans can be performed within 1 hour of a risk factor for brain injury being identified in people attending emergency departments with a head injury.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local protocols.

Process

Proportion of emergency department attendances of people with a head injury for which a CT head scan is performed within 1 hour of a risk factor for brain injury being identified.

Numerator – the number in the denominator having a CT head scan within 1 hour of a risk factor for brain injury being identified.

Denominator – the number of emergency department attendances of people with a head injury and a risk factor for brain injury indicating the need for a CT head scan.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The Trauma Audit and Research Network (TARN) collects data for a subset of the population in the measure. TARN collects data on CT scans performed within 1 hour of arrival for people with a head injury and Glasgow Coma Scale (GCS) score of less than 13.

Outcome

Mortality from skull fracture and intracranial injury.

Data source: Indicator P00103 in NHS Digital's Compendium of Population Health Indicators. Directly standardised rate, all ages, 3‑year average.

What the quality statement means for different audiences

Service providers (emergency departments, hospitals, major trauma centres, trauma units and specialist neurological centres) ensure that a CT head scan can be performed within 1 hour of a risk factor for brain injury being identified in people with a head injury.

Healthcare professionals ensure that CT head scans are performed within 1 hour of a risk factor for brain injury being identified in people with a head injury.

Commissioners ensure that service providers can perform CT head scans within 1 hour of a risk factor for brain injury being identified in people with a head injury. This may be achieved in a number of ways, including the use of 1‑hour targets in acute contracts or enhanced monitoring and audit procedures.

People with a head injury who have any sign showing that the injury might have damaged their brain have a CT scan of their head within 1 hour of the sign showing.

Source guidance

Head injury: assessment and early management. NICE guideline NG232 (2023), recommendations 1.5.8, 1.5.10 and 1.5.11

Definitions of terms used in this quality statement

Risk factors for brain injury

For people aged 16 and over with a head injury, any of the following risk factors indicates the need for a CT head scan within 1 hour of the risk factor being identified:

a GCS score of 12 or less on initial assessment in the emergency department
a GCS score of less than 15 at 2 hours after the injury on assessment in the emergency department
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
post‑traumatic seizure
focal neurological deficit (neurological problems restricted to a particular part of the body or a particular activity)
more than 1 episode of vomiting.

[NICE's guideline on head injury, recommendation 1.5.8]

For children and young people aged under 16 with a head injury, any of the following risk factors indicates the need for a CT head scan within 1 hour of the risk factor being identified:

suspicion of non‑accidental injury
post‑traumatic seizure
on initial emergency department assessment, a GCS score of less than 14 or, for babies under 1 year, a GCS score (paediatric) of less than 15
at 2 hours after the injury, a GCS score of less than 15
suspected open or depressed skull fracture, or tense fontanelle
any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
focal neurological deficit (neurological problems restricted to a particular part of the body or a particular activity)
for babies under 1 year, a bruise, swelling or laceration of more than 5 cm on the head.

[NICE's guideline on head injury, recommendation 1.5.10]

In addition, children and young people aged under 16 with a head injury and more than 1 of the following risk factors should have a CT head scan within 1 hour of the risk factors being identified:

loss of consciousness lasting more than 5 minutes (witnessed)
abnormal drowsiness
3 or more discrete episodes of vomiting
dangerous mechanism of injury (high‑speed road traffic accident as a pedestrian, cyclist or vehicle occupant, fall from a height of more than 3 m, high‑speed injury from a projectile or other object)
amnesia (anterograde or retrograde) lasting more than 5 minutes (it will not be possible to assess amnesia in children who are preverbal and is unlikely to be possible in children under 5)
any current bleeding or clotting disorder.

[NICE's guideline on head injury, recommendation 1.5.11]