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Head injuries: a study evaluating the impact of the NICE head injury guidelines
  1. Z Hassan1,
  2. M Smith1,
  3. S Littlewood1,
  4. O Bouamra1,
  5. D Hughes1,
  6. C Biggin2,
  7. K Amos2,
  8. A D Mendelow3,
  9. F Lecky1
  1. 1Hope Hospital, Salford
  2. 2North Tyneside General Hospital, North Tyneside
  3. 3Neurosurgery Department, Newcastle General Hospital, Newcastle
  1. Correspondence to:
 Zia Hassan
 Emergency Medicine, Hope Hospital Salford, 13 Minister Drive, Urmston, Manchester, M41 5HA;


Background: The NICE head injury guidelines recommend a different approach in the management of head injury patients. It suggests that CT head scan should replace skull x ray (SXR) and observation/admission as the first investigation. We wished to determine the impact of NICE on SXR, CT scan, and admission on all patients with head injury presenting to the ED setting and estimate the cost effectiveness of these guidelines, which has not been quantified to date.

Design: Study of head injury patients presenting to two EDs before and after implementation of NICE guidelines

Methods: The rate of SXR, CT scan, and admission were determined six months before and one month after NICE implementation in both centres. The before study also looked at predicted rates had NICE been applied. This enabled predicted and actual cost effectiveness to be determined.

Result: 1130 patients with head injury were studied in four 1 month periods (two in each centre). At the teaching hospital, the CT head scan rate more than doubled (3% to 7%), the SXR declined (37% to 4%), while the admission rate more than halved (9% to 4%). This represented a saving of £3381 per 100 head injury patients: greater than predicted with no adverse events. At the District General Hospital, the CT head scan rate more than quadrupled (1.4% to 9%), the SXR dropped (19 to 0.57%), while the admission rate declined (7% to 5%). This represented a saving of £290 per 100 head injury patients: less than predicted.

Conclusion: The implementation of the NICE guidelines led to a two to fivefold increase in the CT head scan rate depending on the cases and baseline departmental practice. However, the reduction in SXR and admission appears to more than offset these costs without compromising patient outcomes.

  • CT, computed tomography
  • ED, emergency department
  • GCS, Glasgow Coma Score
  • GDG, guideline development group
  • NICE, National Institute for Health and Clinical Excellence
  • NTGH, North Tyneside General Hospital
  • SIGN, Scottish Intercollegiate Guidelines Network
  • SXR, skull x ray
  • admission
  • head injury
  • imaging
  • NICE HI guideline

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  • ED, emergency department; GCS, Glasgow Coma Score; NTGH, North Tyneside General Hospital.

  • Funding: this study was sponsored and funded by the Trauma audit and research network (TARN).

  • Competing interests: none declared

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