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Diagnosis and management of minor head injury in the UK

05 August 2011
Features
02 August 2011
Volume 3 · Issue 8

Abstract

Head injury accounts for a large amount of emergency services work in the UK. We performed a review of current practice in the management of minor head injured patients (GCS 13-15) by way of a survey of UK emergency departments. Nearly all departments (∼95%) reported unrestricted access to computer tomography (CT) scans. Admission rates for minor head injured patients were 18% for adults and 9% for children. From our systematic review, we identified the most accurate clinical decision rule for adults (Canadian CT Head Rule) and children (Pediatric Emergency Care and Research Network) and commented on the applicability of these in the UK population. We also identified the most significant clinical findings that increase the likelihood of intracranial and neurosurgical injury, following minor head injury in adults, children and infants. Finally, we have highlighted where these findings may be relevant to UK paramedic practice, in particular in influencing the decision to transfer patients to the emergency department. This article summarizes the findings of studies undertaken for the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme examining the available evidence regarding the diagnostic management of minor head injuries. It will be published in a number of articles and a full report for the HTA programme.

Head injury accounts for approximately 700 000 emergency department (ED) attendances in England and Wales each year (National Institute for Health and Clinical Excellence (NICE), 2007), 90% of which are classified as minor (Glasgow Coma Score (GCS) 13–15). Diagnostic assessment can either use a clinical decision rule or unstructured assessment of individual clinical features to identify those who are at risk of intracranial injury and require computed tomography (CT) scans and/or hospital admission.

In moderate or severe head injury management, pathways are clearly structured with in-hospital care being essential to treatment (Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2006; NICE, 2007). However, with minor head injuries, approximately 8% will sustain intracranial injury and only 1% will require any specialist intervention (NICE, 2007). Management of this large proportion of patients involves a balance between under-investigation, which risks missed opportunities to provide early effective treatment for intracranial injury and over-investigation, which risks unnecessary radiation exposure and wasting of NHS resources.

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Decision rule
Emergency medicine
Head injury
Trauma