In June 1999, the Galasko report of the Royal College of Surgeons of England recommended that in the next 5 years, the Accident and Emergency (A&E) departments should admit and supervise head-injured patients for up to 48 h. A prospective observational study was carried out for a 6 weeks period at the A&E department of Birmingham Heartland's Hospital to identify the potential impact of implementation of the Galasko report. The cost implications of this perceived additional workload were considered.Of the 786 head-injured patients seen during study period, 665 (85%) were discharged home directly from the A&E department. Of the remaining 121 patients, who were hospitalized, 76 (63%) were admitted to the A&E observation ward (AEOW) and 19 (16%) patients were admitted to a paediatric ward. All of these patients were discharged home within 24 h. The remaining 21% patients were admitted to other specialities and had prolonged stays in hospital. All of the 9% of the patients admitted under orthopaedics would have been admitted to the AEOW if the Galasko recommendations were implemented leading to an extra 22 bed days over the 6 weeks study period. The estimated annual cost of admission alone for these patients would be pound 38,200. Our study has demonstrated an expected additional workload and cost implications on a single A&E department.