The National Institute of Clinical Excellence Head Injury Guidelines: A summary to assist implementation

T he National Institute for Clinical Excellence guidelines aim to improve the quality of healthcare. They provide evidence based recommendations for the treatment and care of patients with specific disorders. The guidelines can be used to develop standards of care and provide a useful tool for auditing clinical practice. In 2003, NICE first published guidelines for the management of head injured patients (Clinical Guideline 4). In September, 2007, an extensive update including amendments to existing advice and new recommendations was published (CG 56). The guidelines and the update were compiled by a large panel of interested parties after an exhaustive review of the available literature. This paper aims to summarise the features of head injury care as recommended by the guidelines. The objective of care for head injured patients is to ensure timely recognition and treatment of significant injuries in an appropriate healthcare setting. The NICE guidelines have led to a shift in management from an “admit and observe” strategy to a “diagnose and decide” approach. The guidelines provide advice on pre-hospital management, assessment in the emergency department, investigation for brain and cervical spine injuries (see Boxes 1, 2 and 3), recommendations for referral and transfer to a neurosurgical unit (see Box 4) and guidelines regarding the admission, care and discharge of brain injured patients (see Box 5). The key features of the guidelines include the following: • Head injured patients should be transported to a facility with the resources to resuscitate, investigate and provide initial management of multiple injuries. The initial assessment and management should follow the principles of the Advance Trauma Life Support system. For patients with a GCS 3-8 the paramedic crew should make a stand-by call to ensure that appropriate personnel are available to treat the patient at the receiving hospital. The National Institute of Clinical Excellence Head Injury Guidelines: A Summary to Assist Implementation Neurosurgery Article