ORIGINAL ARTICLE

The impacts and outcomes of implementing head injury guidelines: clinical experience in Thailand

Sanguansin Ratanalert¹, Thirawat Kornsilp², Nakarin Chintragoolpradub³, Suwit Kongchoochouy⁴

¹ Neurosurgical Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90112, Thailand
² Ranod Hospital, Songkla 90140, Thailand
³ Sathingphra Hospital, Songkla 90190,Thailand
⁴ Rattaphum Hospital, Songkla 90180, Thailand

Correspondence to:
Correspondence to:
Dr Sanguansin Ratanalert
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla 90112, Thailand;sanguansin.r{at}psu.ac.th

Objective: To describe the impact of implementing clinical practice guidelines (CPG) for head injury in a trauma referral system in Songkla province, Thailand.

Methods: The CPG was developed by a local multidisciplinary team and implemented using multi-faceted methods. The outcome of patients with head injury from three community hospitals and a university hospital (Songklanagarind Hospital) was reported in terms of "talk and deteriorate" patients and a "poor" outcome for patients with severe head injury. Changes to clinical practice were observed where the guidelines were implemented.

Results: 1000 patients with head injury were enrolled from 1st August 2005 to 15th January 2006. The incidence of "talk and deteriorate" patients was 10.5% and a poor outcome was noted in 35.5% of patients with severe head injury, similar to the results of a previous study in Songklanagarind Hospital (p>0.05). Following implementation of the guidelines, 19.8% of patients underwent CT scanning with similar outcomes for alert patients with and without basal skull fracture (p>0.05). The clinician—nurse relationship also improved and there was closer collaboration between hospitals. Short observation in community hospitals for repeat neurological examination may be an appropriate strategy for management of some patients with minor head injury.

Conclusions: Local ownership, an appropriate implementation strategy and working as a multidisciplinary team are key factors for success in implementing the CPG. Basal skull fracture may not be an absolute criterion for CT imaging of the head. Further initiatives will be developed in response to the incidence of "talk and deteriorate" patients.

Abbreviations: CPG, clinical practice guidelines; GCS, Glasgow Coma Scale; LOC, loss of consciousness

Keywords: guideline; head injury; impact; implementation

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