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Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults [CG176]

Measuring the use of this guidance

Recommendation: 1.4.9

For children who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified: Suspicion of non-accidental injury Post-traumatic seizure but no history of epilepsy. On initial emergency department assessment, GCS less than 14, or for children under 1 year GCS (paediatric) less than 15. At 2 hours after the injury, GCS less than 15. Suspected open or depressed skull fracture or tense fontanelle. Any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign). Focal neurological deficit. For children under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head. A provisional written radiology report should be made available within 1 hour of the scan being performed. [new 2014]

What was measured: Of children who underwent a head CT scan, proportion that where done within 1 hour.
Data collection end: February 2010
33%
Area covered: Multiple Regional
Source: Archives of Disease in Childhood 2016 VOL 101 PP 929-934 Selecting children for head CT following head injury Kemp A, Nickerson E, Trefan L, Houston R, Hyde P, Pearson G, Edwards R, Parslow R C, and MacOnochie I


Recommendation: 1.8.7

Perform and record observations on a half-hourly basis until GCS equal to 15 has been achieved. The minimum frequency of observations for patients with GCS equal to 15 should be as follows, starting after the initial assessment in the emergency department: • Half-hourly for 2 hours. • Then 1-hourly for 4 hours. • Then 2-hourly thereafter [2003]

What was measured: Patients who had correctly performed neurological observations
Data collection end: December 2012
16.3%
Number that met the criteria: / 50
Area covered: Local
Source: Wani ZM. 2013. Audit of neurological observation of head injury patients treated conservatively on trauma and orthopaedic wards. International Journal of Surgery, Vol 11, pp711-712



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