A 7-year-old boy is brought to the Emergency Department by his parents following a fall at a playground approximately 4 hours ago. The child fell from a height of approximately 1 meter, landing on his head. A FY1 resident doctor has assessed him and reported that there are no risk factors for significant head injury. The child appears well and is playing with toys in the waiting area.
Observations:
Heart rate: 95 beats per minute
Respiratory rate: 20 breaths per minute
Blood pressure: 100/65 mmHg
Temperature: 36.8°C
Oxygen saturation: 99% on room air
GCS: 15/15
The examination, as reported to you by the FY1 doctor:
There is a 2cm superficial contusion to the right parietal region with no laceration, depression, or boggy swelling. Pupils are equal and reactive to light. No evidence of CSF leak from ears or nose. Neurological examination is normal with no focal deficits.
Past medical history: No significant past medical history. No history of bleeding disorders. No allergies. Not on any medications.
What is the next best step in management?
Tell the FY1 to discharge the patient home with a head injury advice leaflet
Reassess the patient yourself within 20-30 minutes after finishing your current task
Order an immediate CT scan of the head
Admit the patient for 4-hour neurological observations
Request urgent neurosurgical opinion