Quality statement 5: Access to neuroscience units

Quality statement

People with a head injury who have a Glasgow Coma Scale (GCS) score of 8 or lower at any time have access to specialist treatment from a neuroscience unit.

Rationale

A GCS score of 8 or lower indicates a severe traumatic brain injury. People with GCS scores of 8 or lower will benefit from specialised clinical management provided by a neuroscience unit.

Quality measures

Structure

Evidence of locally agreed transfer protocols between the ambulance service, emergency department, district general hospital and designated neuroscience unit.

Data source: Local data collection.

Process

Proportion of emergency department attendances of people with a head injury and a GCS score of 8 or lower at any time for which there is a documented record of ongoing liaison with or transfer to a neuroscience unit.

Numerator – the number in the denominator for which there is a documented record of ongoing liaison with or transfer to a neuroscience unit.

Denominator – the number of emergency department attendances of people with a head injury and GCS score of 8 or lower at any time.

Data source: Local data collection.

Outcome

Mortality from skull fracture and intracranial injury: directly standardised rate, all ages, 3‑year average.

Data source: The Health and Social Care Information Centre's indicator P00103 in the compendium of population health indicators.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (emergency departments, ambulance services, district general hospitals and specialist neurological centres) ensure that there are agreed protocols for ongoing liaison about the management of head injury in people with a GCS score of 8 or lower, and when to transfer to a neuroscience unit.

Healthcare professionals ensure that people with a head injury and a GCS score of 8 or lower have access to specialist treatment through ongoing liaison with or transfer to a neuroscience unit.

Commissioners (clinical commissioning groups and NHS England) ensure that appropriate pathways and protocols are in place for specialist treatment of head injury in people with a GCS score of 8 or lower through ongoing liaison with and transfer to a neuroscience unit.

What the quality statement means for patients, service users and carers

People with a head injury who show signs of severe brain injury are cared for with advice from specialists in brain injury, or have their care transferred to a clinic that specialises in treating brain injury.

Source guidance

  • Head injury (NICE clinical guideline 176), recommendation 1.7.1.

Definitions of terms used in this quality statement

Glasgow Coma Scale (GCS)

A standardised system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves 3 determinants: eye opening, verbal responses and motor response, all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. [NICE full clinical guideline 176]

Neuroscience unit

A neuroscience unit is a specialist centre or a unit that has facilities for neurosurgery and neurointensive care. [NICE full clinical guideline 176]