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Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?
J L af Geijerstam1, M Britton, C Mebius
1SBU, The Swedish Council on Technology Assessment in Health Care and the Department of Medicine, Karolinska Hospital.
Objective:
To study how patients with minor head injuries are currently managed.
Design:
Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden.
Setting:
All 92 emergency departments in Sweden.
Results:
The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs.
Conclusion:
In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.
