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Not a NICE CT protocol for the acutely head injured child
A P Willis1, S A A Latif, S Chandratre
1Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Insights
Birmingham Children's Hospital (BCH) head injury guidelines reduced computed tomography (CT) scans compared to National Institute of Health and Clinical Excellence (NICE) guidelines. The BCH guidelines are safe and appropriate for pediatric head injury management.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Guideline Development
Background:
- Head injuries are common in children presenting to Emergency Departments (EDs).
- Computed tomography (CT) scans are frequently used for evaluating pediatric head injuries.
- National Institute of Health and Clinical Excellence (NICE) guidelines exist for head injury management.
Purpose of the Study:
- To compare the impact of Birmingham Children's Hospital (BCH) head injury computed tomography (CT) guidelines versus NICE guidelines.
- To assess the effect on the number of children undergoing CT scans for head injuries in the ED.
Main Methods:
- A 6-month retrospective review of all children with head injuries attending BCH ED.
- Data collection on indications for CT scans based on both NICE and BCH guidelines.
- Comparison of CT scan rates according to each guideline.
Main Results:
- 1428 children with head injuries were analyzed.
- BCH guidelines resulted in 4% of children undergoing CT scans.
- Strict adherence to NICE guidelines would have increased CT scans by 8%, with no complications in these additional cases.
Conclusions:
- The BCH head injury guidelines are safe and appropriate for a specialized children's hospital.
- Implementing NICE guidelines could lead to a three-fold increase in pediatric head injury CT scans.
- The study supports the use of tailored, local guidelines for CT utilization in pediatric head injuries.
Aim:
To assess the impact of the introduction of the Birmingham Children's Hospital (BCH) head injury computed tomography (CT) guidelines, when compared with the National Institute of Health and Clinical Excellence (NICE) guidelines, on the number of children with head injuries referred from the Emergency Department (ED) undergoing a CT examination of the head.
Material And Methods:
All children attending BCH ED over a 6-month period with any severity of head injury were included in the study. ED case notes were reviewed and data were collected on a specifically designed proforma. Indications for a CT examination according to both NICE and BCH head injury guidelines and whether or not CT examinations were performed were recorded.
Results:
A total of 1428 children attended the BCH ED following a head injury in the 6-month period. The median age was 4 years (range 6 days to 15 years) and 65% were boys. Four percent of children were referred for a CT using BCH guidelines and were appropriately examined. If the NICE guidelines had been strictly adhered to a further 8% of children would have undergone a CT examination of the head. All of these children were discharged without complication. The remaining 88% had no indication for CT examination by either BCH or NICE and appropriately did not undergo CT.
Conclusions:
Adherence to the NICE head injury guidelines would have resulted in a three-fold increase in the total number of CT examinations of the head. The BCH head injury guidelines are both safe and appropriate in the setting of a large children's hospital experienced in the management of children with head injuries.
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