Mild head injuries: impact of a national strategy for implementation of management guidelines.
BACKGROUND
A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published.


METHODS
A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance.


RESULTS
The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing the patient's level of consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be sent home from the accident and emergency department increased (p < 0.001) from 1 (2%) to 13 (19%).


CONCLUSIONS
The Scandinavian Guidelines for Management of Mild Head Injuries have had a significant impact on management practice in Norwegian hospitals.
Müller
Kay
K
Department of Neurosurgery, University Hospital of North Norway, University of Bergen.
Waterloo
Knut
K
Romner
Bertil
B
Wester
Knut
K
Ingebrigtsen
Tor
T
D000465:Algorithms; D006259:Craniocerebral Trauma / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003663:Decision Trees; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000592:standards* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D015600:Glasgow Coma Scale; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D009313:National Health Programs; D009664:Norway; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000209:etiology