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Service use following attendance at an emergency department with an head injury: a 6-month survey
  1. Helen Seeley1,
  2. Chris Maimaris2,
  3. Judith Allanson3,
  4. John Pickard4,
  5. Peter Hutchinson4
  1. 1Division of Academic Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
  2. 2Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
  3. 3Department of Neuroscience & Rehabilitation Clinic, Addenbrooke's Hospital, Cambridge, UK
  4. 4Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Helen Seeley, Division of Academic Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Hills Road, Box 167, Cambridge CB2 0QQ, UK; hms35{at}medschl.cam.ac.uk

Abstract

Objectives 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.

Design 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.

  • emergency care systems, emergency departments
  • epidemiology
  • Trauma, head

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