title: Are we following the guiding SIGN when managing paediatric head injury?
abstract: OBJECTIVE
  The Scottish Intercollegiate Guidelines Network (SIGN) has published guidelines for the management of children with head injuries. The management of children with head injuries admitted to our local unit under the Paediatric Surgeons has been audited to determine whether or not current practice follows SIGN recommendations.
  
  
  METHODS
  Data were collected retrospectively from the case records of patients admitted between January and December 2007. The SIGN guideline 'Early Management of Patients with a Head Injury' (Guideline 46) was published in 2000 and updated in 2009 (Guideline 110). Head injury admission practices were audited against both guidelines.
  
  
  RESULTS
  The case records of 200 patients were analysed. According to SIGN Guideline 46 (2000), 146 Computed Tomography (CT) scans were indicated but only 24 were performed (16%). The updated Guideline 110 (2009) suggests a CT scan was indicated in 24 patients and should have been considered in a further 87. However, only 12 (50%) and 18 (21%) patients were imaged in these respective groups. Both guidelines indicated neurosurgical review in 13 patients but sought in only 4 (31%). 50 patients were deemed to have suffered a significant head injury warranting follow-up, but this was arranged in only 14 (28%).
  
  
  CONCLUSIONS
  Our study has identified that management of paediatric head injuries in our unit is reliant on clinical acumen rather than the SIGN guidelines when making decisions regarding the need for imaging, neurosurgical review and follow-up. We suggest further investigation is required to determine whether greater awareness and closer adherence with the guidelines would alter clinical outcomes.
authors.affiliation: Department of Paediatric Surgery, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, UK. ian.coulter@doctors.org.uk
authors.forename: I C
authors.initials: IC
authors.lastname: Coulter
authors.forename: P M
authors.initials: PM
authors.lastname: Brennan
authors.forename: G
authors.initials: G
authors.lastname: Duthie
authors.forename: A
authors.initials: A
authors.lastname: Baxter
authors.forename: A J
authors.initials: AJ
authors.lastname: McCabe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed