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© State of Queensland (Queensland Health) 2012 Licensed under: http://creativecommons.org/licenses/by‑nc‑nd/3.0/au/deed.en Contact: CIM@health.qld.gov.au

URN: (Affix identification label here)  
URN: (Affix identification label here)  

URN:

(Affix identification label here)

 

Closed Head Injury (Adult) Clinical Pathway

For all emergency presentations with a closed head injury

Family name:

Given name(s):

Address:

Facility:

Date of birth:

Sex:

Facility: Date of birth: Sex: M F I

M

Facility: Date of birth: Sex: M F I

F

I
I

Clinical pathways never replace clinical judgement. Clinical pathway must be varied

replace clinical judgement. Clinical pathway must be varied if not clinically appropriate for the individual patient.

if not clinically appropriate for the individual patient.

Signature Log (Every person using this pathway must supply a sample of their initials and signature below)

Initial

Print Name

Designation

Signature

Initial

Print Name

Designation

Signature

Initial assessment

Date:

/

/

   

Time

Initial

1. Date and time of symptom onset or accident

 

/

/

:

hrs

unknown

unknown

   

2. Document in clinical record:

2. Document in clinical record: Airway / c-spine   Breathing Circulation Disability    

Airway / c-spine

 
2. Document in clinical record: Airway / c-spine   Breathing Circulation Disability    

Breathing

2. Document in clinical record: Airway / c-spine   Breathing Circulation Disability    

Circulation

2. Document in clinical record: Airway / c-spine   Breathing Circulation Disability    

Disability

   

3. Perform first set of neurological observations, pupil response

     
If GCS less than 15 on arrival, escalate to most senior medical officer, continue pathway

If GCS less than 15 on arrival, escalate to most senior medical officer, continue pathway and regular observations.

Legend

Legend Enter time completed Initial when completed Document variance on page 2 Progress Notes (overleaf)

Enter time completed

Legend Enter time completed Initial when completed Document variance on page 2 Progress Notes (overleaf)

Initial when completed

Legend Enter time completed Initial when completed Document variance on page 2 Progress Notes (overleaf)

Document variance on page 2 Progress Notes (overleaf)

CLOSED HEAD INJURY (ADULT) CLINICAL PATHWAY Risk Stratification High Risk Head Injury If ‘yes’ to
CLOSED HEAD INJURY (ADULT) CLINICAL PATHWAY
Risk Stratification
High Risk Head Injury
If ‘yes’ to any, consider high risk.
Stratify as low risk if ‘no’ to all.
Airway maintenance and/or
C-spine protection
If CT scanner available, CT
Yes
Ongoing clinical observations
- Coagulation studies
to
Yes No
Notify senior medical officer
ANY
:
Anticoagulant / Antiplatelet
therapy (including aspirin)
Indications for early CT:
CT normal
Age over 65 years
CT abnormal /
CT unavailable
Deterioration in GCS
Known coagulopathy
Clinical suspicion of skull
(e.g. liver disease, factor deficiency)
Loss of consciousness > 5 mins
fracture
Post traumatic seizure
Focal neurological deficit
Telephone neurosurgical service
for advice or
Telephone RFDS / RSQ
Dangerous mechanism of injury
Anterograde or retrograde
(1300 799 127) for transfer options.
Document advice.
amnesia > 30mins
Persistent abnormal
:
Post traumatic seizure
GCS<15 2hrs
post injury
Persistent GCS < 15 at 2 hrs post
injury
Other clinical concern
Admit / transfer patient:
:
Admitted
Transferred
Deterioration in GCS
Discharged (see page 2)
No to all
Yes to any
:
Clinical suspicion of skull fracture
Unwitnessed head injury
Low Risk Head Injury
Known previous neurosurgery
and/or neurological impairment
Intoxicated (alcohol and or other
drugs)
Airway maintenance and/or C-spine
protection
Perform and record clinical observations
on Neurological Observations Chart
No
to
ALL
Focal neurological deficit
4 hours
post
Observations, GCS and orientation remain appropriate for culture
and previous function
Persistent vomiting
injury
Absence of persistent vomiting or severe headache
Absence of persistent post-traumatic amnesia
Persistent severe headache
No other clinical concerns
:
Persistent abnormal level of
alertness, behaviour and/or
cognition
Yes to all
No to any
Refer to most senior medical
Multi-system trauma
Discharge when clinically safe to appropriate
social environment with responsible person
officer and re‑stratify to high risk
Delayed presentation or
Re-presentation
:
Multiple co-morbidities or
combination of worrying factors
Instructions and ED fact sheet “Minor Head Injury” given to carer/patient
GP letter completed on discharge?
Yes
No
:
:
v3.00 ‑ 08/2012
DO NOT WRITE IN THIS BINDING MARGIN
ÌSW214kÎ
Mat. no.: 10255150
SW214

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URN: (Affix identification label here)
URN: (Affix identification label here)

URN:

(Affix identification label here)

 

Family name:

Closed Head Injury (Adult) Clinical Pathway

Given name(s):

Address:

 

Date of birth:

Sex:

  Date of birth: Sex: M F I

M

  Date of birth: Sex: M F I

F

I
I
Discharge Time Initial Give patient / carer Queensland Health Emergency Department fact sheet “Minor Head
Discharge
Time
Initial
Give patient / carer Queensland Health Emergency Department fact sheet “Minor Head Injury”
Following discharge, patients on anticoagulants, known coagulopathy or bleeding disorder
should be referred for follow-up within 72 hours due to an increased risk of delayed intracranial
haemorrhage
Give patient / carer discharge letter
Discharge into care of a responsible adult
Clinical Events / Variance / Progress Notes
DO NOT WRITE IN THIS BINDING MARGIN
Date / Time
Describe variances to clinical pathway and any other patient related notes.
Document as Variance / Action / Outcome
Initials

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