Head injuries: a study evaluating the impact of the NICE head injury guidelines.
BACKGROUND
The NICE head injury guidelines recommend a different approach in the management of head injury patients. It suggests that CT head scan should replace skull x ray (SXR) and observation/admission as the first investigation. We wished to determine the impact of NICE on SXR, CT scan, and admission on all patients with head injury presenting to the ED setting and estimate the cost effectiveness of these guidelines, which has not been quantified to date.


METHODS
Study of head injury patients presenting to two EDs before and after implementation of NICE guidelines


METHODS
The rate of SXR, CT scan, and admission were determined six months before and one month after NICE implementation in both centres. The before study also looked at predicted rates had NICE been applied. This enabled predicted and actual cost effectiveness to be determined.


RESULTS
1130 patients with head injury were studied in four 1 month periods (two in each centre). At the teaching hospital, the CT head scan rate more than doubled (3% to 7%), the SXR declined (37% to 4%), while the admission rate more than halved (9% to 4%). This represented a saving of 3381 pounds sterling per 100 head injury


METHODS
greater than predicted with no adverse events. At the District General Hospital, the CT head scan rate more than quadrupled (1.4% to 9%), the SXR dropped (19 to 0.57%), while the admission rate declined (7% to 5%). This represented a saving of 290 pounds sterling per 100 head injury patients: less than predicted.


CONCLUSIONS
The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes.
Hassan
Z
Z
Emergency Medicine, Hope Hospital Salford,Urmston, Manchester. ziauddin_hassan@yahoo.com
Smith
M
M
Littlewood
S
S
Bouamra
O
O
Hughes
D
D
Biggin
C
C
Amos
K
K
Mendelow
A D
AD
Lecky
F
F
D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards*; D004739:England; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000191:economics / Q000592:standards; D006769:Hospitals, General / Q000191:economics / Q000592:standards; D006784:Hospitals, Teaching / Q000191:economics / Q000592:standards; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*