Impact of implementation of NICE Guidelines: CT scan for head injury patients at district general hospital setting

Abstract

Abstracts 123Discussion: The high incidence of trauma due to assaults and alcohol warrants the implementation of preventative measures. The prevalence of these preventable injuries have significant financial implications for the NHS and incur a human cost to the victims and their families that is impossible to quantify. The frequency of alcohol association in this setting was higher than that in previous studies carried out in the United Kingdom (30% versus 20%). 1 These findings support the need for public health measures to reduce the incidence of interpersonal violence attributable to alcohol consumption. Reference1 Hutchinson IL, Magennis P, Shepherd JP, Brown AE. The BAOMS United Kingdom Survey of Facial Injuries Part 1: Aetiology and the association with alcohol consumption. Br J Oral Aim: To assess the implications of implementation of the NICE Guidelines for indication for CT scan in head injury patients. Methods and materials: A retrospective audit of the patients attending our district general hospital with head injuries over a period of one year from October 2004 till Sept 2005. A total of 3150 patients attending the A&E during the study period were diagnosed to have head injuries. Of this total 135 required admission. The study involved review of the case notes and radiology results of the 135 patients requiring inpatient treatment for head injury. During this tenure the CT scan was requested depending of the clinical judgement of the attending physician.Results: Rigid compliance with the NICE Guidelines during the study tenure would have entailed an additional workload of 36 patients requiring a CT scan, of which 28 patients justified the scan during out of hours period. One elderly patient with a fatal intracerebral bleed was found to have justified an early CT scan on the criteria of more than one vomiting episode and a history of unconsiousness.Discussion: The implementation of NICE Guidelines was found to be implemented in most cases admitted during working hours. A reluctance to perform CT scan was encountered during out of hours. A strict compliance with the guidelines would entail on an average one additional CT scan every fortnight during the 'out of hours' period. A consentual agreement was reached with the radiology department to continue neuro-observations overnight for such patients till the next morning when the CT scan would be then performed. Implementation of NICE Guidelines was found to tighten the net (and justify a CT scan) in order not to miss subtle early signs of potentially fatal head injuries.