[The NHG practice guideline 'Head injury']

Area of Science:

• Emergency Medicine
• Primary Care
• Neurology

Background:

• General practitioners (GPs) frequently manage patients presenting with head injuries.
• Existing multidisciplinary guidelines for head injury management are often too defensive for primary care settings.
• The Dutch College of General Practitioners (NHG) developed a new guideline tailored for primary care.

Purpose of the Study:

• To provide GPs with a practical guideline for managing patients with head injuries.
• To differentiate risk factors for intracranial injury in primary care compared to secondary care.
• To establish clear referral criteria for patients with potential intracranial injury.

Main Methods:

• Adaptation of existing multidisciplinary guidelines for primary care use.
• Identification and appraisal of specific risk factors for intracranial injury.
• Differentiation of risk factors based on patient age (≥ 16 years vs. < 16 years).

Main Results:

• The a priori probability of complications is lower in general practice, necessitating different risk factor appraisal.
• Anticoagulant use (coumarin, DOACs, LMWH) warrants specialist consultation or referral; thrombocyte aggregation inhibitors do not.
• Specific criteria for urgent referral include unconsciousness, focal neurological deficits, seizures, basal skull fracture, or high-energy trauma suspicion.

Conclusions:

• The NHG guideline provides a less defensive and more appropriate approach for GPs managing head injuries.
• Clear criteria exist for specialist referral in cases of suspected intracranial injury.
• For patients without referral indications, advising regular waking with written instructions is recommended.