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The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review
Helen Barratt1, Mark Wilson, Fionna Moore
1Health Care Evaluation Group, Department of Epidemiology and Public Health, University College London, London, UK. h.barratt@public-health.ucl.ac.uk
Insights
NICE guidelines recommend transferring more head injury patients for specialist care, but UK neurosurgical units lack capacity. This could worsen access and strain resources for all patients.
Area of Science:
- Neurosurgery
- Traumatic Brain Injury Management
- Healthcare Resource Allocation
Background:
- Head injury is a leading cause of death in young UK adults, presenting a significant burden on National Health Service (NHS) resources.
- Current management of head injuries is inconsistent, largely dictated by available local resources.
- National Institute for Health and Care Excellence (NICE) guidelines suggest increased transfer of traumatic brain injury patients for specialist care.
Purpose of the Study:
- To critically evaluate the evidence base for NICE recommendations on transferring patients for neurosurgical care.
- To examine the current configuration of specialist neurosurgical services.
- To assess the implications of increasing patient transfers on service capacity and access.
Main Methods:
- A systematic literature review was performed.
- Included articles discussed the provision of emergency neurosurgical care for adult head injuries within the UK.
- Fifty-eight papers were selected, including those cited by NICE and those addressing bed occupancy, transfer times, and policies.
Main Results:
- The evidence cited by NICE for head injury transfer recommendations is of variable quality.
- A significant portion of the reviewed research originated outside the UK, questioning its direct applicability to the NHS.
- UK neurosurgical units already face inadequate capacity to meet current demand for traumatic brain injury care.
Conclusions:
- Increasing patient transfers for neurosurgical care is likely to exacerbate existing capacity issues within UK neurosurgical units.
- Enhanced transfer policies could worsen access inequalities for other patient groups, including elective surgical patients.
- The current infrastructure and capacity of regional neurosurgical services may not support the proposed increase in patient transfers.
Unlabelled:
Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources. The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. However, this raises issues about the capacity of regional neurosurgical units, particularly to accommodate patients who do not require surgical intervention.
Objectives:
To critically evaluate the basis of the NICE recommendations about transfer for neurosurgical care, and examine the configuration of specialist services to assess the implications of increasing the existing number of transfers.
Methods:
A systematic literature review was conducted of articles discussing the provision of emergency neurosurgical care for adult head injuries in the UK.
Results:
Fifty-eight papers met the criteria for inclusion in the literature review, including seven papers cited in the NICE guidance. Fifty-one papers related to neurosurgical care, including papers on bed occupancy, transfer times and transfer policies.
Conclusions:
The evidence NICE cited is of variable quality. Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched.
