Recurring concern
Failure of head injury assessment and treatment pathways to reliably recognise and manage head injuries
Pin
Get email alerts
Request correctionFirst reported 31 Oct 2013•Latest report 26 Jun 2026
What this concern includes
Includes deficiencies in dedicated head injury assessment or treatment pathways and their controls, including clinical decision support, triage, referral, escalation, admission, guidance, policy alignment and discharge arrangements, when they affect recognition or management of head injuries.
Not included
- Excludes generic staffing, training, documentation or communication deficiencies not explicitly tied to the head injury assessment or treatment pathway.
- Excludes unrelated injury, falls, anticoagulation, emergency transport or clinical governance concerns unless they specifically concern recognition or management of a head injury.
- Excludes deficiencies in pathways for other conditions, even where the failure mechanism is similar.
- Reports
- 28
- Individual concerns
- 33
- Date range
- 2013–2026
- Stated actions
- 46
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
-
Concerns raised2
Lack of a clear head-injury management policy
Failure to provide and adjust neurological observations after head injury
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Failure to identify serious injuries following road traffic collisions
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
Action
Review the care provided on 4 May 2018.
Stated by East and North Hertfordshire Teaching NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
Clinical findings did not require head or forearm imaging; assessment and national guidance supported no further investigation.
Stated by East and North Hertfordshire Teaching NHS Trust
-
Concerns raised1
NICE guidelines inadequately addressing slow intracranial bleeding after falls in elderly patients
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
Action
Conduct the ongoing surveillance review of the head injury guideline to determine whether it requires updating.
Stated by National Institute for Health and Care Excellence -
Action
Publish the final surveillance review decision in September 2019.
Stated by National Institute for Health and Care Excellence
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
-
Position
NICE guidelines do not apply to the organisation, so it will not undertake work to address their adequacy.
Stated by Shaw Healthcare Limited
-
Position
The Chief Executive of NICE is responsible for responding to concerns about the adequacy of NICE guidelines.
Stated by Shaw Healthcare Limited -
Position
Existing NICE head-injury guidance already applies to injuries caused by both direct and indirect trauma.
Stated by National Institute for Health and Care Excellence
-
Concerns raised1
Failure of paramedics to recognise that the extent of a head injury after a fall may not be immediately obvious and to apply extra caution
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Failure to apply the NICE head injury guideline before attributing depressed consciousness to intoxication
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
Action
Develop a tool guiding staff to exclude brain injury safely in intoxicated patients, including examination findings and a step-by-step head examination.
Stated by Royal United Hospitals Bath NHS Foundation Trust -
Action
Establish a pathway for senior review and further investigation when intoxicated patients do not recover within the expected timeframe after significant head injury is excluded.
Stated by Royal United Hospitals Bath NHS Foundation Trust
-
Concerns raised1
Failure to undertake further imaging in borderline presentations of significant head injury
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
No further investigations were considered necessary because there were no clinical signs indicating a need at the time.
Stated by Recipient name withheld
-
Concerns raised1
Failure to ensure guideline-compliant CT scanning for patients with head injuries, especially those taking anti-coagulant medication, during on-site CT scanner service issues
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
Action
Implement a CT scanner downtime escalation and dissemination process, supported by senior managers on call, out-of-hours protocol reminders, and posters in relevant clinical areas.
Stated by Manchester University NHS Foundation Trust -
Action
Provide training on NICE guidelines for hospital-acquired head injuries and require all new starters to complete it during Trust induction.
Stated by Manchester University NHS Foundation Trust
-
Concerns raised1
Failure of clinical decision support software to register head injuries
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
-
Position
Existing head-injury questioning and NICE-consistent triage are considered sufficient to identify relevant risks and provide the appropriate emergency response.
Stated by NHS Pathways
-
Position
The Trust cannot change NHS Pathways because it is designed and managed by NHS Digital.
Stated by South Central Ambulance Service NHS Foundation Trust -
Position
Responsibility for reviewing and changing NHS Pathways should be directed to NHS Digital.
Stated by South Central Ambulance Service NHS Foundation Trust
-
Concerns raised1
Failure to perform CT head scans after significant facial and head bruising
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
Action
Recheck head-injury and inpatient-falls policies against NICE and NPSA standards.
Stated by Sandwell and West Birmingham Hospitals NHS Trust -
Action
Install the new electronic patient record to provide decision support and alerts reinforcing inpatient-falls and head-injury standards.
Stated by Sandwell and West Birmingham Hospitals NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
Existing head-injury and inpatient-falls policies meet NICE and NPSA standards and remain suitable for staff use.
Stated by Sandwell and West Birmingham Hospitals NHS Trust
-
Concerns raised1
Lack of guidance on when to recommence Warfarin after head injury
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
Action
Consider extending the head-injury guideline’s scope to examine evidence and develop recommendations on restarting warfarin during the 2017 update.
Stated by National Institute for Health and Care Excellence
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Position
Specific recommendations on restarting Warfarin after head injury cannot be made without extending the guideline’s scope.
Stated by National Institute for Health and Care Excellence
Data last updated 7 September 2026