New Scandinavian guidelines aim to support emergency care professionals in the assessment of adults with minimal, mild and moderate head injuries. Based on a broad review of the evidence, the guidelines include a more individualised approach to head computed tomography and in-hospital observation. The study was led by researchers at several departments, including Karolinska Institutet and Stockholm South General Hospital and is published in The Lancet Regional Health - Europe.
Head injuries are a common reason for visits to emergency departments. Most are mild, but healthcare professionals need to identify patients at risk of bleeding or other traumatic injuries inside the skull who may need urgent treatment. At the same time, patients at low risk should not undergo unnecessary imaging or hospital admission.
The previous Scandinavian guidelines were updated in 2013. Since then, the population has aged, the use of antithrombotic therapy has changed, and new blood biomarkers for brain injury have become available.
The researchers have therefore reviewed the state of the evidence again. In total, 110 studies on the risk of traumatic intracranial injury and 33 studies on the risk of emergency neurosurgical treatment were included. After this, 29 experts and other stakeholders from the Nordic countries took part in developing the new recommendations.
"Our aim is to give healthcare professionals clearer support when deciding which patients need a head CT or admission for observation, and which patients can be safely discharged without imaging. The assessment should be based on the patient's overall risk profile," says Li Jin Yang , lecturer at the Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet.
A more individual assessment
One change concerns antithrombotic therapy. Instead of treatment with an anticoagulant automatically leading to a head CT, it is considered together with other risk factors, such as age, suspected loss of consciousness and repeated vomiting. The guidelines also identify structured observation as an alternative to immediate CT for selected patients.
Another new element is that the blood biomarkers GFAP and UCH-L1 may be used to help rule out the need for a head CT in selected patients.
"We want to use head CT and clinical observation where they are most useful, while quickly identifying patients with signs of a more serious injury. The new guidelines make it possible to adapt the assessment to the patient's risk factors and to the resources available locally," says Eric Thelin , associate professor and research group leader at the Department of Clinical Neuroscience, Karolinska Institutet.
The researchers also emphasise that the certainty of evidence is limited for several recommendations. The safety and effectiveness of the updated guidelines therefore need to be evaluated in future studies.
Publication
"The Scandinavian Neurotrauma Committee 2026 guidelines for initial management of minimal, mild and moderate head injuries in adults: a systematic review, meta-analysis and modified Delphi consensus study" . Yang LJ, Undén J, Fletcher-Sandersjöö A, et al. The Lancet Regional Health - Europe, online 7 November 2026, doi: 10.1016/j.lanepe.2026.101911.
