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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue SUPP_II, 208.  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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British Orthopaedic Specialists Association

London, England: 25 April 2007

President: Mr A Choudhary

FEASABILITY OF IMPLEMENTATION OF NICE GUIDELINES: CT SCAN FOR HEAD INJURY AT DISTRICT GENERAL HOSPITAL SETTING

R. Kakwani; D. Chakrabarti; and A. Das

Good Hope Hospital NHS Trust, Sutton Coldfield

Aim: To assess the implications of implementation of the NICE Guidelines for indication for CT scan in head injury patients.

Methods and Materials: A retrospective audit of the patients attending our district general hospital with head injuries over a period of one year from October 2004 till Sept 2005. A total of 3150 patients attending the A & E during the study period were diagnosed to have head injuries. The study involved review of the case notes and radiology results of the 135 patients requiring inpatient treatment for head injury. During this tenure the CT scan was requested depending of the clinical judgement of the attending physician.

Results: Rigid compliance with the NICE Guidelines during the study tenure would have entailed an additional workload of 36 patients requiring a CT scan, of which 28 patients justified the scan during out of hours period.

One elderly patient with a fatal intracerebral bleed was found to have justified an early CT scan on the criteria of more than one vomiting episode and a history of unconsiousness.

Discussion: The NICE Guidelines were found to be implemented in most cases admitted during working hours. A reluctance to perform CT scan was encountered during out of hours. A strict compliance with the guidelines would entail on average one additional CT scan every fortnight during the ‘out of hours’ period. Implementation of NICE Guidelines was found to tighten the net (justify CT scan) in order not to miss subtle early signs of potentially fatal head injuries.

Correspondence should be addressed to Mr Bimal Singh, c/o BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General