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Brain injury - Diagnosing a severe head injury

NHS Choices Medical Reference

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A severe head injury should always be treated in hospital.

If any of the symptoms of a severe head injury are present, immediately go to the accident and emergency (A&E) department of your local hospital or call 999 and ask for an ambulance.

The healthcare professionals treating you will need to ask some questions to help with the diagnosis and treatment of your injury including:

  • how you were injured
  • when you were injured
  • if you have been drinking alcohol
  • if you have taken any illegal drugs

If you cannot remember how your injury occurred, ask someone who saw your accident to describe it to you, if possible.

You will be asked about your symptoms, for example:

  • whether you have lost consciousness
  • whether you have a headache
  • whether you have been sick

If you are with someone who has a head injury, try to provide as much information as possible about the accident and the person's symptoms.

The paramedics or doctors treating you will assess your condition using the Glasgow Coma Scale (GCS), described below.

Glasgow Coma Scale

After a head injury, healthcare professionals use the Glasgow Coma Scale (GCS) to assess how severely your brain has been damaged. The GCS scores you on:

  • your verbal responses (whether you can make any noise)
  • your physical reflexes (whether you can move)
  • how easily you can open your eyes

Your score for each of these three areas is added up to give a total. A slightly different version of the GCS is used for children under five years old.

A score of 15 (the highest possible score) means that you know where and who you are, you can speak and move as instructed, and your eyes are open.

A score of three (the lowest possible score) means that you cannot open your eyes and you cannot move or make a noise. The score indicates that your body is in a deep coma (a sleep-like state where you are unconscious for a long time).

Depending on your score, head injuries are classed as:

  • minor: a score of 13 or more
  • moderate: a score of 9-12
  • severe: a score of 8 or less

Based on your assessment, you may be:

  • allowed to go home
  • referred to hospital (if you are not already at a hospital)
  • sent for further testing and treatment

Going home

You will only be allowed to go home after a head injury if:

  • an examination shows you are at low risk of brain injury
  • your symptoms have not met the criteria for being referred to hospital (see below)

You will need someone to take you home because you will not be allowed to drive until you have completely recovered. If possible, you will also need someone to stay with you for the first 48 hours after your injury.

The doctors treating you will advise about what to do and what not to do in the weeks following your injury. Read more about recovering from a severe head injury for more information about caring for a head injury at home.

Referral to hospital

You will be referred to the emergency department of a hospital (if you are not already at one) if any of the following apply to you:

  • you have any of the symptoms of a severe head injury
  • you have a GCS score of 14 or less
  • you were involved in a 'high-energy' head injury, for example if your injury was caused by a car or bike accident or a fall from a height of more than 1m (3ft) or five stairs
  • you have previously had brain surgery
  • you have previously had, or still have, a bleeding or clotting condition (a condition that affects the blood's ability to thicken properly)
  • you are currently taking an anticoagulant (blood-thinning) medicine, such as warfarin, you are currently drunk or you have been taking illegal drugs
  • you are 65 years of age or over
  • it is possible that the injury was not accidental, for example you deliberately hurt yourself or someone else hurt you on purpose
  • the healthcare professional with you is concerned about your diagnosis

Further testing

In some cases, further tests may be necessary to determine how serious your head injury is and whether you are at risk of developing any complications of a severe head injury. The tests you need and how urgently you need them will depend on:

  • your symptoms
  • your GCS score
  • your medical history
  • the circumstances of your injury

Tests you may need are described below.

Computerised tomography (CT) scan

A (CT) scan involves a series of X-rays being taken of your body from different angles. This produces a detailed image of the inside of your body.

A CT scan can be used to examine the bone, muscle and tissue in your neck, to check for any damage and to identify whether there is any bleeding or inflammation (swelling) in your brain.


An X-ray uses radiation to take pictures of the bones inside your body. An X-ray may not help diagnose a brain injury, but it can be used to check for any breaks or fractures in your skull or other bones in your body.

Magnetic resonance imaging (MRI) scan

An MRI scan uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.

An MRI scan can measure changes in blood flow in the brain and detect damage to the brain or spinal cord.

Test results

Depending on your test results, you may be allowed to go home, but usually you will be kept in hospital for a short time. This is to make certain that your injury has not caused any serious problems.

Medical Review: March 20, 2012
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