title: [Practice guideline 'Management of patients with mild traumatic head/brain injury' in the Netherlands].
abstract: OBJECTIVE
  To evaluate the effect of the revised practice guideline 'Management of patients with mild traumatic head/brain injury' (MHI) in the Netherlands using the number of CT scans of the cerebrum, number of hospital admissions, and the number of intracranial traumatic findings on CT scan.
  
  
  METHODS
  Retrospective before-and-after study.
  
  
  METHODS
  A structured chart review over the 3-month period considerable time after implementation of the MHI guideline (study period) was compared with the 3-month-period before its introduction (control period). Both children and adults were included. Primary outcome measures were the percentage of hospital admissions and percentage of cerebrum CT scans in patients with MHI. Secondary outcome measures were traumatic findings on CT scan, neurosurgical intervention and adherence to the guideline.
  
  
  RESULTS
  During the study and control periods, respectively 1063 and 1026 patients with MHI attended the emergency department of the study centre. During the study period a CT scan was carried out in 34.2% of patients, significantly more than in the control period 18.8%; p < 0.01). The percentage of admissions also increased from 13.8% to 18.2% (p = 0.01). The differences between the two periods were mainly in adults and in children aged 6 and older. There was no significant change in traumatic intracranial findings or neurosurgical interventions. Adherence to the guideline in regard to hospitalization (81.7% guideline adherence) and CT brain imaging (88.3% guideline adherence) was reasonably high.
  
  
  CONCLUSIONS
  After introduction of the current MHI guideline in the Netherlands, percentages of both hospitalization and CT of cerebrum have increased significantly. It was expected that the guideline would result in decreases of this percentages. This increase does not seem to be related to more or serious head/brain injury.
authors: Medisch Centrum Haaglanden, Den Haag.
authors: Crispijn L
authors: CL
authors: van den Brand
authors: A H J H Annelijn
authors: AH
authors: Rambach
authors: Roelie
authors: R
authors: Postma
authors: Victoria  L
authors: V
authors: van de Craats
authors: Frank
authors: F
authors: Lengers
authors: Christa P
authors: CP
authors: Bénit
authors: Femke C
authors: FC
authors: Verbree
authors: Korné
authors: K
authors: Jellema
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult