title: Service use following attendance at an emergency department with an head injury: a 6-month survey.
abstract: OBJECTIVE
  To survey the attendance of patients presenting with a head injury (HI) at a UK emergency department (ED), identifying numbers, types of service and referral routes; to survey subsequent service use and to highlight the challenges in service planning and identifying which patients may potentially benefit from follow-up/rehabilitation input.
  
  
  METHODS
  A retrospective population-based case series study using multiple prospective and retrospective data sources.
  
  
  METHODS
  Adults from the National Health Service (NHS) Cambridgeshire catchment area attending an ED over a 6-month period with a HI were identified from detailed ED reports, and any service use within the hospital after injury was tracked using a number of data sources.
  
  
  RESULTS
  1036 patients presented on 1081 occasions with a HI during the 6 months. Of the 1081 HIs, 979 (91%) were mild (Glasgow Coma Scale (GCS) score 13-15), 70 (6%) were moderate (GCS score 9-12), and 32 (3%) were severe (GCS score <9). A number of types of referral routes and systems were identified and analysed: 873 (81%) patients were discharged directly from ED, with four offered HI-specific follow-up. Of 208 admissions, 27 (2%) were to neurosurgical care, and 35 (3%) patients were offered HI-specific follow-up, 24 of these being in a specialist neurotrauma clinic. Follow-up started between 1 and 18 months after injury. At 24 months after injury, follow-up for 10 of these was still ongoing.
  
  
  CONCLUSIONS
  These study findings highlight the difficulties in identifying patients who would benefit from follow-up, in particular after mild HI. Our study findings will form the basis of a long-term follow-up study.
authors.affiliation: Division of Academic Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Seeley
authors.affiliation: Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Maimaris
authors.affiliation: Department of Neuroscience & Rehabilitation Clinic, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Allanson
authors.affiliation: Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK.
authors.forename: John
authors.initials: J
authors.lastname: Pickard
authors.affiliation: Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hutchinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult
keywords: Trauma, head; emergency care systems, emergency departments; epidemiology