Prospective Audit of the Management of Head Injuries in a Small District General Hospital

Abstract

Abstract Background and Aims: In September 2000 the Scottish Intercollegiate Guidelines Network published their recommendations on the optimal early management of head injured patients. Early identification of significant intracranial pathology through CT scanning is central to these guidelines. At our small DGH, head injured patients are received and managed by general surgeons with no specific training in head trauma. In addition, there is as yet no arrangement in place for urgent CT scanning. Because of these factors, an audit was conducted to determine the extent to which we were able to comply with these guidelines. Methods.: A 2 month prospective audit of the management of head injured patients was carried out collecting data on patient demographics, clinical condition on admission, clinical course, radiological investigations (and difficulty in arranging them) and outcome. Results: Over the 2 month period 52 consecutive patients were studied. Fifteen patients met criteria for CT scanning, of which 9 were ultimately scanned. Tellingly, only one of the fifteen received their scan within the recommended four hour period. In this series, no patient had an adverse clinical event related to delay in scanning. Conclusion: Any hospital admitting head injured patients should have 24 hour access to CT scanning facilities. If such an arrangement is not in place then patients with head injuries should not be admitted to that hospital.