The NICE guidelines for the management of head injury: the view from a district hospital

Leaman, A M

doi:10.1136/emj.2004.015024

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…The aim of NICE guidance is to maximise the quality and consistency of patient care, but this document has been criticised because the evidence base for many of the other recommendations is limited and from non-UK settings 24. Resource availability was also outside their terms of reference,25 prompting calls for a ‘more realistic’ alternative taking this into account 26…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…In fact, it appears that, taking all costs into account, the CT strategy is actually one-third less expensive than that of inhospital observation [17]. Despite this, at present, radiology departments throughout the UK are not sufficiently well resourced to cope with the CT strategy as advocated by NICE [18][19][20].…”

Section: Discussionmentioning

confidence: 98%

Implications of full compliance with the computed tomography scanning recommendations of the National Institute for Clinical Excellence and Scottish Intercollegiate Guidelines Network guidelines for the management of head injury

Kerr

Beard

Smith

et al. 2007

European Journal of Emergency Medicine

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A prospective study was conducted to examine clinical practices in the management of head-injured patients preinception and postinception of the Scottish Intercollegiate Guidelines Network guidelines. Comparison was made between the Scottish Intercollegiate Guidelines Network and National Institute for Clinical Excellence guidelines on their indications for computed tomography scanning. Information was available on 2827 adult patients. Two hundred and thirty-two patients satisfied one or more Scottish Intercollegiate Guidelines Network criteria for computed tomography scanning. Four hundred and seventy-eight patients fulfilled one or more National Institute for Clinical Excellence criteria for scanning. No patient with Scottish Intercollegiate Guidelines Network or National Institute for Clinical Excellence indications for computed tomography scanning and who was not scanned, subsequently required neurosurgical treatment for a complication related to their injury. Full compliance with the scanning recommendations in the Scottish Intercollegiate Guidelines Network and National Institute for Clinical Excellence guidelines will require a significant increase in scanning resource and is unlikely to lead to the identification of a significant additional number of patients with intracranial lesions requiring neurosurgical intervention.

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“…As a result of national guidance [2], the number of computed tomography (CT) of the brain performed in patients with minor head injury has increased significantly [3][4][5]. The impact of this upon anaesthetic services is not known.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography of the brain in the emergency department

Wiles¹,

Harvey²,

Coleman³

et al. 2011

European Journal of Emergency Medicine

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As a result of national guidance in the UK, the number of computed tomography brains performed in patients with minor head injury has increased significantly. The aim of this survey was to establish the requirement for general anaesthesia and tracheal intubation in the management of emergency department patients requiring an urgent computed tomography of the brain. About 300 consecutive scans in emergency department patients were reviewed. The majority (>90%) did not require anaesthetic airway management despite an overall acute scan diagnosis rate of around 25% and 30 day mortality of 10%.

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The NICE guidelines for the management of head injury: the view from a district hospital

Cited by 17 publications

References 8 publications

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

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

Implications of full compliance with the computed tomography scanning recommendations of the National Institute for Clinical Excellence and Scottish Intercollegiate Guidelines Network guidelines for the management of head injury

Computed tomography of the brain in the emergency department

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