title: [The NHG practice guideline 'Head injury'].
abstract: General practitioners frequently treat patients with head injuries. The Dutch College of General Practitioners' (NHG) practice guideline has been developed because the existing multidisciplinary guideline on head injury 'Treatment of patients with mild traumatic head/brain injury' ('Opvang patiënten met licht traumatisch hoofd/hersenletsel') is too defensive for use in primary care. The a priori probability of complications is lower in general practice than in secondary care, so selection and appraisal of risk factors for intracranial injury are different to those in the multidisciplinary guideline mentioned above. Risk factors for intracranial injury differ slightly for patients aged ≥ 16 years and for patients aged < 16 years. Use of anticoagulants--coumarin derivatives, direct oral anticoagulants, and low-molecular-weight heparin, but not thrombocyte aggregation inhibitors--is a reason for consultation with, or referral to, a specialist. Criteria for urgent referral are unconsciousness or diminished level of consciousness, focal neurological deficits, post-traumatic fits or seizures, basal skull fracture or suspicion of high-energy trauma. In the case of patients with no indication for referral, advising that the patient should be woken up at regular intervals could be included in the consultation provided written instructions were given.
authors.affiliation: *Namens de werkgroep NHG-standaard 'Hoofdtrauma', waarvan de overige leden aan het eind van dit artikel staan vermeld.
authors.forename: L Willem
authors.initials: LW
authors.lastname: Draijer
authors.forename: Miranda J
authors.initials: MJ
authors.lastname: Kurver
authors.forename: Wim
authors.initials: W
authors.lastname: Opstelten
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000628:therapy; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D058006:General Practice / Q000592:standards*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D012017:Referral and Consultation; D012307:Risk Factors; D012887:Skull Fractures; D015599:Trauma Severity Indices
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight