Management of traumatic head injuries in a rural Irish hospital: Implications of the NICE guidelines

Background: The NICE guidelines were published in 2003 in an effort to standardise the management of traumatic head injuries, and advise a CT brain in certain situations. Aim: To evaluate the influence of the NICE guidelines on the management of head injuries in a county hospital. Methods: Complete clinical data were obtained for all patients with traumatic head injuries attending the ED of a county hospital from 2001 to 2005. Symptoms, examination details and outcome data were made available. The influence of the NICE guidelines on their management was then evaluated. Results: Application of the NICE guidelines to these patients would have resulted in a 56% increase in the rate of CT brains being performed. No patient who did not have a CT brain had an adverse outcome. Conclusion: It is possible with limited resources and normal neurological observations that patients over the age of 65 can be managed safely.