title: An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury.
abstract: BACKGROUND
  The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention.
  
  
  METHODS
  We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline.
  
  
  RESULTS
  The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p < 0.05). Noncompliance was caused by overtriage in 362 cases (30%) and undertriage in 80 (7%). Guideline compliance was 54% in 2005, 71% in 2007, and 64% in 2009.
  
  
  CONCLUSIONS
  This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital-Ullevål, Oslo, Norway.
authors.forename: Ben
authors.initials: B
authors.lastname: Heskestad
authors.forename: Knut
authors.initials: K
authors.lastname: Waterloo
authors.forename: Tor
authors.initials: T
authors.lastname: Ingebrigtsen
authors.forename: Bertil
authors.initials: B
authors.lastname: Romner
authors.forename: Marianne Efskind
authors.initials: ME
authors.lastname: Harr
authors.forename: Eirik
authors.initials: E
authors.lastname: Helseth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000628:therapy*; D003952:Diagnostic Imaging; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009664:Norway; D017410:Practice Guidelines as Topic; D055815:Young Adult