ABC of major trauma. Head injuries--II.

* Confusion or any other depression of consciousness at the time of the examination * Skull fracture * Neurological symptoms or signs, or both * Difficulty in assessing the patient-for example, because of ingestion of alcohol, epilepsy, or other medical conditions that cloud consciousness; children are also difficult to assess * Lack of a responsible adult to supervise the patient and other social problems. Brief amnesia after trauma with full recovery is not necessarily an indication for admission. If the patient is to be observed outside hospital he or she should be discharged with a head injury "warning card" into the care of a responsible person. The aims of hospital admission are to provide optimal conditions for recovery of the brain and to detect complications before they cause further secondary brain damage. The mainstay of admission is therefore neurological observation, which should be hourly for at least the first 24 hours.