Application of the Canadian CT head rules in managing minor head injuries in a UK emergency department: implications for the implementation of the NICE guidelines

Sultan, Heebah; Boyle, Adrian; Pereira, Marco Magalhaes; Antoun, Nagui; Maimaris, C

doi:10.1136/emj.2003.011353

Cited by 71 publications

(52 citation statements)

References 2 publications

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“…The NICE guidance only identifies a very limited role for skull radiography and use in the NHS has decreased accordingly. [21][22][23] Computerised tomography scanning definitively shows significant bleeding and a normal CT scan effectively excludes a significant bleed at the time of scanning. Magnetic resonance imaging (MRI) can detect some lesions that are not evident on CT, 33 but arguably none that is of clinical importance and certainly none that influences early management.…”

Section: Description Of Technology Under Assessmentmentioning

confidence: 99%

“…Of the titles and abstracts screened, 12 relevant full papers were retrieved and assessed in detail. 21,22,37,136,[152][153][154][155][156][157][158][159] One RCT 37 comparing immediate CT during triage with observation in hospital for patients with MHI fulfilled the inclusion criteria. A flow chart describing the process of identifying relevant literature can be found in Appendix 7.…”

Section: Studies Included In the Reviewmentioning

confidence: 99%

“…data presented as structured tables with a narrative description, but without a formal quality assessment). The two contemporaneous cohort studies 152,153 compared alternative hospital admission policies, whereas nine uncontrolled before/after studies 21,22,136,[154][155][156][157][158][159] evaluated the effect of introducing guidelines for head injury management. A summary of the study and patient characteristics is presented in Table 23.…”

Section: Additional Evidencementioning

confidence: 99%

“…Sultan et al 21 evaluated the effects of a protocol based on the CCHR (the Cambridge protocol) for managing MHIs compared with guidelines published by the Society of British Neurological Surgeons, 1998, and Royal College of Surgeons for England, 1999. The results showed that CT rates increased significantly from 14% to 20% (p < 0.05), and admissions for observation increased from 34% to 45% (p < 0.05).…”

Section: Cohort Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

111

114

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTADiagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA...

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Section: Description Of Technology Under Assessmentmentioning

confidence: 99%

Section: Studies Included In the Reviewmentioning

confidence: 99%

Section: Additional Evidencementioning

confidence: 99%

Section: Cohort Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

111

114

View full text Add to dashboard Cite

show abstract

“…At some rural hospitals, patients requiring CT are transported 1-1.5 hours by land ambulance to another hospital for scanning thus lengthening the time in confirming a diagnosis and impacting the ability to conform to Canadian guidelines (Stiell, Lesiuk, Wells, Coyle, et al, 2001; for CT scanning which recommends CT if GCS score < 15 at 2 hours after injury. In areas where CT scanning was limited, the rate of hospital admissions for mild TBI was reported to be higher (Sultan, Boyle, Pereira, Antoun, & Maimaris, 2004). Limited access to imaging services could adversely impact on patient outcomes as CT scans provide diagnostic value to cases where TBI is suspected and may be a contributing factor to the higher rates of Diversity of Research in Health Journal / Revue de la Diversité de la Recherche en Santé Vol 1, pp 44-60, April 2017 53 hospitalization for head injury reported in northern Ontario (Compass, 2008).…”

Section: Northern and Rural Healthmentioning

confidence: 99%

Neurological Assessment in the Acute Care Practice Environment of Northern Ontario Hospitals

St-Denis

Wenghofer

Young

et al. 2017

DRHJ

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Traumatic brain injury (TBI) is a leading cause of death and disability in developed countries and in Ontario. Trauma is the primary cause of neurological injury contributing to disability and loss of productive years. Neurological assessment remains the cornerstone to identifying evolving injury and planning care. A comprehensive assessment including all components related to neurological function, such as Glasgow Coma Scale (GCS), pupillary size and light reactivity, limb strength and vital signs, is paramount if the nurse is to initiate prompt action by medical personnel meant to improve survival outcomes and minimize long term sequelae. Clinical surveillance is essential in the identification of physiological changes and is vital in deciding whether computerized tomography (CT) is necessary. This is especially important in regions where a return trip for diagnostic testing can extend the length of time in reaching a medical diagnosis and treatment. Recent studies have indicated gaps in the documentation of neurological assessment. Numerous studies have examined factors that influence patient outcomes following TBI, few have looked at the short term outcomes of immediate care for mild TBI and none could be found to suggest on-going clinical surveillance provided in the first six hours contributed to positive or negative outcomes.

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Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult With Minor Head Trauma?

Easter

Haukoos

Meehan

et al. 2015

JAMA

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Combinations of history and physical examination features in clinical decision rules can identify patients with minor head trauma at low risk of severe intracranial injuries. Certain findings, including signs of skull fracture, GCS score of 13, 2 or more vomiting episodes, decrease in GCS score, and pedestrians struck by motor vehicles, may help identify patients at increased risk of severe intracranial injuries.

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Application of the Canadian CT head rules in managing minor head injuries in a UK emergency department: implications for the implementation of the NICE guidelines

Cited by 71 publications

References 2 publications

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Neurological Assessment in the Acute Care Practice Environment of Northern Ontario Hospitals

Will Neuroimaging Reveal a Severe Intracranial Injury in This Adult With Minor Head Trauma?

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