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Emergency head injury imaging: implementing NICE 2007 in a tertiary neurosciences centre and a busy district general hospital
  1. J S Mooney1,
  2. A Yates2,
  3. L Sellar2,
  4. T Shipway2,
  5. C Roberts2,
  6. R Parris3,
  7. Z Hassan1,
  8. M Thomas1,
  9. M Smith1,
  10. F Lecky1,4
  1. 1Salford Royal Foundation NHS Trust, Emergency Department, Salford, UK
  2. 2University of Manchester Medical School, Manchester, UK
  3. 3Royal Bolton Hospital Foundation NHS Trust, Emergency Department, Bolton, UK
  4. 4Trauma Audit and Research Network, Health Sciences Research Group, School of Community based Medicine, Manchester Medical Academic Health Sciences Centre, Salford Royal Hospital, Salford, UK
  1. Correspondence to F Lecky, Trauma Audit and Research Network, Health Sciences Research Group, School of Community based Medicine, Manchester Medical Academic Health Sciences Centre, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK; fiona.lecky{at}


Background Head injuries are a common emergency department (ED) presentation. The National Institute for Health and Clinical Excellence (NICE) updated its guidance in September 2007 regarding imaging required for patients with head injuries.

Methods A two-centre observational ED study was carried out, examining imaging practice in adults and children with head injuries attending pre-guideline and post-guideline implementation. Guideline implementation occurred through a formal implementation programme at the teaching hospital, and informally at the district general hospital (DGH). Retrospective extraction took place of prospectively recorded data case records and radiology department imaging registers. Pre-implementation data were collected from Salford Royal Foundation NHS Trust (SRFT) from January and February 2008 and post-implementation data in May 2008. Post-implementation data was collated from Royal Bolton Hospital Foundation NHS Trust (RBFT) from September to November 2007. Compliance with NICE 2007 was the primary outcome assessed.

Results With the implementation of NICE 2007 guidelines at SRFT, a significant increase in compliance from 94.2% (92.9–95.5) to 98.8% (98.2–99.3) was observed for adults requiring head CTs, with an overall trend to improved clinical practice in the adult patient populations. However, a significant number of children (SRFT 68.7% and RBFT 77.1%) did not receive the indicated head CT scan following a head injury, after implementation of the guidelines.

Conclusions The SRFT implementation strategy employed was successful for adults, with the overall trend to increased clinical compliance post-guideline introduction. Evidence of a reluctance to adhere to the NICE recommendations for children indicated for CT head scan after a head injury was observed.

  • Imaging
  • trauma
  • head

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  • Funding This research was funded in part by a Foulkes Foundation Fellowship for A Yates.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.