• Children aged 1-16 can be considered for nurse-led discharge by appropriately trained staff, as per the criteria below.

• If there are any concerns the child should be seen by an ED clinician, even if they meet the criteria for nurse-led discharge.

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Abbreviations

Children over the age of one can be considered for nurse-led discharge by qualified nurses who are up-to-date with Level 3 Safeguarding training, and who have been assessed in the use of this pathway. If there are concerns with any child presenting with a head injury they should be seen by an ED clinician even if they meet the criteria for nurse-led discharge.

All children presenting to ED should have a full triage with documentation including time of incident, history of incident and any self-care at home. Children must have a full set of observations including pupils and ideally blood pressure recorded.

Give analgesia if required and not already given.

Document clearly in the notes and complete the “Nurse-Led Paediatric Head Injury” form on the ED Narrator tab in Epic (see appendix)

Consider safeguarding in all children presenting to the ED with head injury. Complete safeguarding documentation if required and refer those with concerns to the ED clinician.

Give verbal and written advice at discharge and ensure it has been understood.

• Child aged 1-16 inclusive

• Mobile child

• No suspicion of non-accidental injury or any other safeguarding concerns

• No “dangerous mechanism of injury” per NICE Head Injury Guideline:

  • High speed road traffic collision

  • Fall from height >3m

  • High speed injury from projectile or other object

• No loss of consciousness/abnormal drowsiness

• No history of seizure or irritability post head injury

• No vomiting

• No history of amnesia

• No focal neurological deficit (e.g. weakness, reduced/altered sensation, vision or speech disturbance)

• Child not on warfarin and has no known clotting disorders

• Child looks alert and well with no nursing concerns

• GCS 15/15 throughout

• Observations within normal limits including pupils

  • Blood pressure should be recorded in all children where practical, but if measurement is not tolerated this does not preclude nurse-led discharge

• No signs of basal skull fracture

  • “Panda” eyes

  • Fluid/blood from ears

  • Fluid from nose

  • Battle’s sign (bruising behind ears)

• No boggy swelling, no presence of bruise/swelling/laceration >5cm on head

• No other significant injuries (excluding minor abrasions/lacerations that require simple or no closure)