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Are we ready for NICE head injury guidelines in Scotland?
  1. I J Swann1,
  2. T Kelliher1,
  3. J Kerr2
  1. 1Department of Accident and Emergency Medicine, Glasgow Royal Infirmary, Glasgow, UK
  2. 2Accident and Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to:
 Mr I J Swann
 Department of Accident and Emergency Medicine, Glasgow Royal Infirmary, Glasgow G4 0SF, UK;

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The major challenge for A&E is implementation of realistic guidelines

Any guideline that gives priority to the prompt identification of patients at risk of brain injury deserves to be supported and timely imaging (CT brain scan or skull radiograph, or both) is an essential part of this process. Recently published guidelines recognise the increased availability of emergency CT in the UK.1–3 The Scottish Intercollegiate Guidelines Network Publication number 46 (August 2000) recommends the increased use of CT brain scans for selected patients with mild head injury including those with the radiological demonstration of a skull fracture.2

The National Institute for Clinical Excellence: Clinical Guideline (2003)3 includes an adapted form of The Canadian CT head rules,4 which lowers the threshold for scanning patients with mild head injury much further and relies very little on the use of skull radiographs.

A concern is whether such guidelines can be safely and effectively implemented if hospitals in the UK lack the necessary resources for easy access to out of hours CT.

The Canadian CT head rules were …

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