Shelf-inflicted head injuries

To evaluate the diagnostic yield of cranial computed tomography (CT) imaging in patients who sustained minor head trauma after directly hitting their head on a shelf or cupboard, without an associated fall. The study aimed to assess whether such low-impact mechanisms warrant cranial imaging. This was a retrospective observational study conducted at the emergency department of a major trauma centre in the United Kingdom. Data were extracted from the institutional Radiology Information System and electronic health records, covering the period from June 2006 to April 2025. An initial cohort of 320 patients referred for CT head imaging was identified using a keyword-based search of radiology request histories. Of these, 109 patients were included based on a clearly documented mechanism of injury involving impact with a cupboard or shelf, without an associated fall. Exclusion criteria included alternative mechanisms such as falls, falling objects, assault, or irrelevant mentions. The primary outcome was the presence of acute intracranial pathology on CT head. Secondary data collected included age, sex, injury mechanism, clinical symptoms, adherence to National Institute for Health and Care Excellence (NICE) head injury imaging criteria, and any scalp or skull findings. Of the 109 included patients, median age was 48 (31–66), females 76 (70%). Eight patients (7%) had scalp findings, including swelling or laceration. Despite the low-force mechanism, 79 patients (72%) met at least one NICE guideline criterion for imaging, most commonly due to vomiting or anticoagulant use. None demonstrated acute intracranial pathology or skull fracture on the CT head scan. The absence of positive findings suggests that careful vetting of NICE criteria in the context of biomechanically implausible mechanisms may reduce unnecessary imaging. Walking into or standing up and hitting a shelf or cupboard is an insufficient force to generate clinically significant traumatic brain injury. Direct head impact from a fixed object, without an associated fall, appears to be a biomechanically low-risk mechanism. This study supports a more scrutinised and context-aware application of the NICE head injury criteria in such scenarios, to help rationalise imaging demand, optimise resource use, and reduce unnecessary exposure to ionising radiation.