CT Head — Head Injury (adults ≥16)

NICE NG232 (May 2023)v2.0 · March 2026

Varies

All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)

Required Assessment Tools

REQUIRED

GCS

Glasgow Coma Scale — must be documented at initial ED assessment and at 2 hours post-injury

— ANY of the following

GCS ≤12 on initial ED assessment
GCS <15 at 2 hours post-injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture (haemotympanum, 'panda eyes', CSF otorrhoea/rhinorrhoea, Battle's sign)
Post-traumatic seizure
Focal neurological deficit
More than one episode of vomiting
Suspicion of non-accidental injury (NAI)

Within 8 hours

Loss of consciousness or amnesia since the injury, PLUS ANY of the following

Age ≥65 years
History of bleeding or clotting disorder
Dangerous mechanism (pedestrian/cyclist struck by vehicle; ejected from vehicle; fall >1 m or >5 stairs)
Retrograde amnesia >30 minutes before impact

Within 8 hours

CONSIDER CT within 8 hours — shared decision-making applies. Changed from v1.0: now 'consider', not mandatory. Excludes aspirin monotherapy.

Patient on anticoagulant therapy (excluding aspirin monotherapy) without loss of consciousness or amnesia — consider CT head within 8 hoursNICE NG232 Rec 1.5.13

Warning

'Cyclist' is explicitly named in NG232 as a dangerous mechanism — use this term in documentation

NICE NG232

Information

Aspirin monotherapy alone does not require CT unless another criterion is present

Information

Plain skull X-ray is no longer recommended for adults

Radiation Dose

CT head effective dose ~2 mSv (equivalent to ~100 chest X-rays)

Paediatric

Children <16 have substantially different criteria — see CT Head: Head Injury (children <16)

v1.02026-03-05Initial publication

v2.02026-03-08Anticoagulant-without-LOC criterion changed from mandatory to 'consider' per NG232 Rec 1.5.13. NAI indication added.