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

Background Several clinical guidelines exist to identify intracranial injury (ICI) after head injury. The Scandinavian Neurotrauma Committee (SNC) published evidence- and consensus-based guidelines in 2000, updated in 2013. Since then, demographic changes, including an ageing population and increased use of antithrombotic therapy have prompted further revision. The aim of this study is to provide a clinically relevant update to the SNC guidelines for the initial management of adults with minimal, mild, or moderate head injury. Methods A PRISMA-compliant systematic review and meta-analysis addressed population, exposure, comparator, and outcome questions on which emergency department patients with minimal or mild head injury require head computed tomography (CT), direct discharge, in-hospital observation, or repeat CT. Evidence was graded using the GRADE approach. Recommendations were developed through a modified Delphi process with stakeholder review. Findings Twenty-nine stakeholders participated in developing a seven-point recommendation set and updated management flowcharts. Key changes include reduced emphasis on routine CT in patients receiving direct oral anticoagulants, incorporation of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 biomarkers, and use of structured observation as an alternative to CT in selected risk groups. Interpretation The updated guidelines support risk-adapted imaging and observation strategies that may reduce unnecessary CT scans and hospital admissions, although further validation of safety and effectiveness is needed.