An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Eirik Helseth⁴  Marianne Efskind Harr³  Bertil Romner⁵  Tor Ingebrigtsen¹  Knut Waterloo²  Ben Heskestad³ 

[1]Institute for Clinical Medicine, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway

[2]Department of Psychology, Faculty of Health Sciences, University of Tromsø, N-9037 Tromsø, Norway

[3]Department of Neurosurgery, Oslo University Hospital - Ullevål, P.O. Box 4950, Nydalen N-0424, Oslo, Norway

[4]Faculty of Medicine, University of Oslo, P.O.Box 1018, Blindern N-0315, Oslo, Norway

[5]Department of Neurosurgery, Neuroscience Centre, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark

关键词: Compliance;    Implementation;    Guidelines;    Head injury;   

Others  :  826588
DOI  :  10.1186/1757-7241-20-32

 received in 2011-10-09, accepted in 2012-04-17,  发布年份 2012

【 摘 要 】

Background

The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention.

Methods

We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline.

Results

The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p < 0.05). Noncompliance was caused by overtriage in 362 cases (30%) and undertriage in 80 (7%). Guideline compliance was 54% in 2005, 71% in 2007, and 64% in 2009.

Conclusions

This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions.

【 授权许可】

   
2012 Heskestad et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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