Recommendations from the Society of British Neurological Surgeons

Bartlett, John R.; Kett-White, Rupert; Mendelow, A. D.; Miller, J. Lowry; Pickard, J. D.; Teasdale, G. M.

doi:10.1080/02688699844871

Cited by 66 publications

(23 citation statements)

References 8 publications

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“…The medicolegal aspects are difficult to take into account when adopting criteria for CT use, but the Society of British Neurological Surgeons was advised by a leading medicolegal firm to take the view that such guidelines would be unlikely to expose their authors or the Society endorsing them to any significant risk of legal challenge. 1) This study was performed at a single secondary level emergency clinic. Moreover, relatively few cases were evaluated using these proposed indications.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

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The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

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Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

View full text Add to dashboard Cite

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“…Traumas of the head, spine, trunk and shoulder region, if at least one of the following characteristics was present:Any fall;High-energy accident (according to Advanced Trauma Life Support principles, a high-energy (vehicle) accident is defined as initial speed >64 km/h, major car-deformity, intrusion into passenger compartment >30 cm, extrication time from vehicle >20 min, falls >6 m, roll over, auto–pedestrian accidents, or motorcycle crash >32 km/h or with separation of rider and bike13);Unconsciousness;Fracture;Necessity for surgical treatment;Probable transient neurological deficit;Permanent disability.…”

Section: Methodsmentioning

confidence: 99%

Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?

Bednařík

Sládková

Kadaňka

et al. 2010

Journal of Neurology, Neurosurgery & Psychiatry

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“…The first of these were published in 1984,12 and were subsequently superseded by recommendations from the Society of British Neurosurgeons (SBNS)13 and the Royal College of Surgeons of England (RCS) 14 15…”

Section: Introductionmentioning

confidence: 99%

Republished paper: The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review

Barratt

Moore²,

Raine³

2010

Postgraduate Medical Journal

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Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources. The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. However, this raises issues about the capacity of regional neurosurgical units, particularly to accommodate patients who do not require surgical intervention. Objectives To critically evaluate the basis of the NICE recommendations about transfer for neurosurgical care, and examine the configuration of specialist services to assess the implications of increasing the existing number of transfers. Methods A systematic literature review was conducted of articles discussing the provision of emergency neurosurgical care for adult head injuries in the UK. Results Fifty-eight papers met the criteria for inclusion in the literature review, including seven papers cited in the NICE guidance. Fifty-one papers related to neurosurgical care, including papers on bed occupancy, transfer times and transfer policies. Conclusions The evidence NICE cited is of variable quality. Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched.

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Recommendations from the Society of British Neurological Surgeons

Cited by 66 publications

References 8 publications

Indications for Computed Tomography in Patients With Mild Head Injury

Indications for Computed Tomography in Patients With Mild Head Injury

Are subjects with spondylotic cervical cord encroachment at increased risk of cervical spinal cord injury after minor trauma?

Republished paper: The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review

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