Head Injury in Adults - Initial Management, Neurosurgical Referral & MTC Transfer
Last update 16th March 2018
V1 Approved by Policy and Guideline Committee on 16th March 2018 Trust Ref: B38/2018
This guideline has been developed for the East Midlands Major Trauma Network (EMMTN) and
was approved by its Executive Board on 16th February 2018.
1. Introduction and who guidelines apply to
It describes key steps in the initial management of adult patients presenting to the regional Trauma Units (TU) with a head injury in whom CT imaging of the head is indicated as per NICE CG176 ; including indications for immediate transfer to the Major Trauma Centre (MTC) and for
obtaining emergent / urgent neurosurgical advice at Nottingham University Hospitals (NUH) via the online system referapatient.
NB - The following patient groups are outside the scope of this document:
• Those in whom the need for MTC transfer has already been clearly established;
• Those who due to advanced frailty  are deemed not to benefit from CT by an experienced ED doctor or ANP as part of a shared decision-making process involving patient and family.
This guideline applies to all UHL staff involved in the initial management of adult patients presenting to the Leicester Royal Infirmary (LRI) Emergency Department (ED) with head injuries.
2. Guideline Standards and Procedures
2.1 ED management and disposition should follow the algorithm shown in Appendix A.
2.2 Referrals to the neurosurgical team at NUH via referapatient. Watch the video guide below to see how to do this.
2.3 It is NOT necessary to sign up or log in to make a referral. Begin your referral here
Upon completing your first referapatient referral a referapatient account will be automatically generated for you with a password and PIN sent to your email and phone.
ED Clinicians can access to the LRI ED Referapatient ‘Referrals From My Department’ view by emailing Dr Martin Wiese.
3. Education and Training
No additional skills are required to follow this guideline.
Awareness will be raised through the relevant members of the Major Trauma Governance Group (MTGG).
4. Monitoring and compliance
5. Supporting References
1. NICE (2014) Head injury: Triage, assessment, investigation and early management of head injury in children, young people and adults. CG176. London: National Institute for Health and Care Excellence.
2. Rockwood K et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-495.
6. Key Words
Major trauma, head injury, traumatic brain injury, TBI, NICE, GCS, Glasgow Coma Scale, Major Trauma Centre, MTC, frail, frailty, extradural, subdural, subarachnoid, RSI, rapid sequenceintubation, adult, referapatient, neurosurgeon, neurosurgery, Queen’s Medical Centre, QMC,
Nottingham University Hospital, NUH, EMMTN, East Midlands Major Trauma Network,
hydrocephalus, pneumocephalus, fracture
7. Contact and Review details
Guideline Lead, Martin Wiese, Emergency Physician and UHL Clinical Lead for Major Trauma
Executive Lead, Andrew Furlong, Medical Director
Details of Changes made during review:
Adult with Head Injury in Trauma Unit: Initial Management, neurosurgical referral and MTC Transfer
Video Guide (no need to switch on speakers as there is NO sound)
Install our Chrome Extension called Litebox to video-record scans on your screen and upload to your referral in HD
'Does this patient require transfer to QMC?' If not how long should the patient be observed?'
Other questions (if applicable) might include:
For how long should anticoagulation be withheld?
Are any follow-up arrangements necessary?
Does the patient require Pneumovax or other drugs?