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I read with some surprise Dr Leaman's article on the impact of the
NICE guidelines on a district general hospital. I am truly confused at the
level of anxiety this topic is causing in the UK. In most other developed
countries, the use of skull x-rays have long been abandoned in favour of
selected use of CT scans in patients with head injuries.
While I appreciate the increased resource implic...
While I appreciate the increased resource implications inherent in
the extablishment of these guidelines, I really do not see that there is a
viable alternative, apart from reliance on an outdated mode of
investigation (skull x-ray) in what should be a first world setting.
In our paediatric department, we started relying on a modified
version of the American Academy of Pediatrics guidelines since 2001. The
use of skull x-rays have dramatically fallen, while there has only been a
modest rise in the use of CT scans for minor head injured patients.
I do agree with the Dr Leaman's point regarding out of hours scans,
but we really have no firm evidence on which to base our assumption that
patients requiring a scan can always wait until the morninig. On the other
hand, implementation of the NICE guidelines, along with careful audit will
provide us with such data, at which time we can safely modify the
guidelines to suit local practice.
It is time that the UK falls into line with modern practice regarding
the management of head injuries, even if this means an increase in
1. A M Leaman. The NICE guidelines for the management of head injury: the view from a district hospital. Emerg Med J 2004; 21: 400.