WIREDGOV

The National Institute for Health and Clinical Excellence (NICE) has today (26 September 2007) issued the newly updated guideline on the early care of adults and children with head injuries. Developed by the National Collaborating Centre for Acute Care, the NICE clinical guideline gives recommendations on the care and treatment options that should be available in the NHS for people with a head injury. This guideline is a partial update of the original document issued in 2003, revising areas where new evidence has since been published. The guideline also gives some new recommendations, including imaging of children and the need for collaboration between hospitals to achieve optimum care.

Hospital emergency departments see an estimated 750,000 people with head injuries each year. Most head injuries are mild and do not lead to hospital admission, but a small number of people have a moderate or severe injury and may die or go on to have prolonged disability. The advice provided by the guideline includes pre-hospital management, assessment in the emergency department, investigation for clinically important brain and cervical spine injury and indications for specialist referral.

Some recommendations are:

• All patients presenting to an emergency department with a head injury should be assessed by a trained member of staff within 15 minutes of arrival at hospital
• For patients with specified risk factors, computed tomography (CT) imaging of the head should be performed and results analysed within 1 hour of the request having been received by the radiology department
• Children aged under 10 who are in a coma should have CT imaging of the cervical spine within 1 hour of presentation or as soon as they are sufficiently stable
• Where a patient with a head injury requires hospital admission, it is recommended that the patient only be admitted under the care of a team led by a consultant who has been trained in the management of this condition during his/her higher specialist training.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE and Executive Lead for the guideline, said: “Around 750,000 people with a head injury are seen at hospital emergency departments each year. All of these patients will benefit from this guideline, which sets out how care should be provided for people with head injury. Fortunately, the vast majority of head injuries are mild, but for injuries that are moderate or severe, it’s vital that health professionals can quickly and effectively diagnose and manage these cases. This guideline gives updated recommendations based on new evidence, as well as some new advice, which should ensure that health professionals can deliver the best possible care to all patients with head injury.”

Professor David Yates, Chair of the Guideline Development Group, said: “The first NICE guideline on head injury proved to be of enormous help to health professionals, setting out best practice in assessing and managing head injury. This partial update builds on the earlier advice, and includes some new recommendations. For example it recommends that patients with serious head injuries are transferred to a specialist neuroscience unit, wherever possible, for the benefit of the patient and irrespective of the need for neurosurgery. The guideline draws upon the expertise of a range of health professionals and patient representatives who understand the complexities of diagnosing and managing head injury. It sets standards for all health professionals on the best ways to provide care.”

Paul Sidi, Guideline Development Group member patient representative, said: “I’m delighted to see these updated national standards on managing head injury have patient-centred care at their core. Head injuries can be frightening not just for the patient, but also their families. As well as advice for medical staff, the guideline gives clear advice on helping patients and their families understand what might happen at the hospital, and beyond. It includes information on the tests that may be performed, what care should be provided and practical advice for people being discharged after head injury. Importantly, the guideline says that all patients and their carers should be made aware of the possibility of long-term symptoms, personality changes and disabilities following head injury, and of services that can help them. This guideline should give reassurance that anyone with a head injury will receive the best possible care and treatment.”

Professor David Lloyd, Guideline Development Group member and paediatric surgeon, said: “The guideline will help health professionals to update practice based on the available evidence, to ensure the service provided improves the outcome for patients. The guideline’s updated advice will assist with the rapid assessment of head injury in children and adults, and in ensuring that patients promptly receive the appropriate imaging when needed. New recommendations for imaging children with head injury are included, as well as advice that observation of admitted infants and children under 5 should be performed in units with staff trained and experienced in the observation of infants and young children. We expect that implementation of the guideline will increase the early detection of clinically important brain and cervical spine injuries, promoting rapid and effective treatment.

Notes to Editors

About the guidance

1. The guidance is available at http://www.nice.org.uk/CG56  (from 26 September 2007)

About NICE

2. NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:

• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.