Facts and Figures

According to the National Institute for Health and Care Excellence (NICE) 1.4 million people attend A & E in England and Wales each year following a head injury. Up to 700,000 will be children under the age of 15.

Early detection and prompt treatment is vital to save lives and minimise risk of disability, the updated guidance from NICE tells us. However a person may appear fine at first, particularly at the accident scene as it is not uncommon for symptoms of head injury to manifest themselves during the post accident phase for up to 72 hours.

We now know that the process by which injury to the axons in the brain takes place occurs due to a cascade of events that can take up to 72 hours to become fully apparent. This is one reason why ambulance and A & E personnel often fail to detect or record any symptoms of head injury. Another reason is because A & E casualty staff may not appreciate that a patient who responds appropriately to simple questions is actually in post traumatic amnesia.

On 22nd January 2014 NICE updated their guidance on head injury for hospital doctors, nurses and ambulance crews. Key changes in the guidance include:

  • Ambulance crews should take patients with a head injury straight to a hospital with resuscitation facilities where doctors and nurses can investigate and treat their injuries.
  • Children and adults who have suffered a head injury but also begin to show particular signs that the injury may be serious or potentially life-threatening (such as seizures, suspected skull fracture, repeated vomiting or loss of consciousness should be given a CT brain scan within one hour. Others should be scanned within four to eight hours of their injury, depending on its severity.
  • A hospital doctor or specialist who is trained in safeguarding (for example, potential abuse) should be involved in checking any patient with a head injury presenting to A&E, especially if it’s a possible non-accidental injury or a vulnerable person has been injured.
  • Doctors and nurses should give verbal and printed advice to patients, with any type of head injury who are discharged from an emergency department or observation ward, and their families and carers. Any advice should be accessible and appropriate to the patient’s age.

Symptoms of Brain Injury

Cognitive Symptoms Emotional and Behavioural Symptoms Physical Symptoms
Short term memory Disinhibited temper Dizziness / sickness
Concentration Impulsive spending patterns Persistent headaches
Difficulty learning new information Disinhibited behaviour Persistent cumulative fatigue
Word finding / fluency Lack of insight Visual disturbance including light sensitivity
Difficulty multitasking Anxiety and depression Noise sensitivity
Difficulty problem solving Impulsivity Change in sense of smell or taste
Slower speed of thought Change in sexual drive / function Difficulty with fine coordination
Difficulty under pressure Loss of motivation

The above list is typical of the more subtle brain injuries. With the more severe injuries additional physical problems may present to include physical disability, significant speech problems and epilepsy.