Evaluation of the Scandinavian guidelines for head injuries based on a consecutive series with computed tomography from a Norwegian university hospital

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Anne Vik¹  Kent Gøran Moen¹  Ole Solheim²  Ingrid Haavde Strand³ 

[1] Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, N-7006, Norway;MI-Lab, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, N-7006, Norway;Department of Radiology and Diagnostic Imaging, St.Olavs University Hospital, Trondheim, N-7006, Norway

关键词: Traumatic brain injury;    Minor head injury;    Guideline compliance;    CT scan;   

Others  :  826369
DOI  :  10.1186/1757-7241-20-62

 received in 2012-04-10, accepted in 2012-08-28,  发布年份 2012

【 摘 要 】

Background

This study prospectively assesses clinical characteristics and management of consecutive minimal, mild and moderate head injury patients referred for CT scans. Compliance with the Scandinavian head injury guidelines and possible reasons for non-compliance is explored.

Methods

From January 16^th 2006 to January 15^th 2007, 1325 computed tomography (CT) examinations due to minimal, mild or moderate head injury according to the Head Injury Severity Scale (HISS) were carried out at our University Hospital. When ordering a CT scan due to head trauma, physicians were asked to fill out a questionnaire.

Results

Guideline compliance was impossible to assess in 49.5% of all cases. This was due to non-assessable or missing key variables necessary in the decision making algorithm. One or more key variables for HISS classification were not assessable in 34.4% as it was unknown whether there had been loss of consciousness (LOC), duration of LOC was unknown or it was impossible to assess amnesia or focal neurologic deficits. Definite compliance with both CT and admittance recommendations in guidelines was seen in only 31.2%. In 54.2% of patients with minimal head injuries who underwent CT scans, imaging was not necessary according to guidelines. 59.1% of all patients were admitted to hospital, however only 23.7% of these were admitted because of the head-injury alone. Age < 4 years, possible medical cause of injuries, severe headache/nausea or vomiting and the presence of non-traumatic CT findings were independently associated with non-assessable compliance with Scandinavian guidelines. Suspicion of influence of alcohol was inversely associated to non-compliance.

Conclusions

Despite the prospective study design, guideline compliance was not assessable in nearly half of the patients. Patients with isolated head injuries and available and obtainable complete clinical information necessary for guideline-based decision making are not dominating in a head injury population.

【 授权许可】

   
2012 Strand et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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