Aim To assess how child emergency department (ED) attendances are distributed between hospitals across England, Wales and Northern Ireland and how care is organised for children with a head injury.

Methods A cross-sectional survey was performed of the 245 hospitals in England Wales, Northern Ireland and the Crown Dependencies (Channel Islands and Isle of Man) which were eligible to participate in the enquiry from September 2009 to April 2010. The survey covered hospital details, departments and procedures, ED activity, imaging, admission and discharge procedures, referral and transfer, documentation, training and audit, information and advice, and non-accidental head injuries.

Results 64% of hospitals have an established pathway for management of head injured children. Not infrequently hospitals asserting designation as specialist trauma or specialist neurosurgical centres do not offer an intensive care service for children. 82% of child ED attendances are to hospitals that would not care for a critically ill child on-site. Hospitals that do offer such care are much more likely to have children's trained staff available in the ED. They are also more likely to have access to surgical support beyond neurosurgery.

Conclusion Given the extent of variation between hospitals in the facilities available for head injured children, further comparative studies into the standards of care delivered and outcomes (including a confidential enquiry) are indicated.