Republished paper: The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review
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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Helen Barratt1, Mark Wilson, Fionna Moore
1Academic Clinical Fellow, Health Care Evaluation Group, Dept Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. h.barratt@public-health.ucl.ac.uk.
Insights
NICE guidelines recommend increased transfer of head injury patients for specialist care. However, UK neurosurgical units lack capacity, potentially worsening access and exacerbating existing service strain.
Area of Science:
- Neuroscience
- Public Health
- Health Services Research
Background:
- Head injury is a leading cause of mortality in young UK adults, imposing a significant burden on National Health Service (NHS) resources.
- Current management of head injuries in the UK is inconsistent, largely dictated by local resource availability.
- The National Institute for Health and Care Excellence (NICE) guidelines advocate for increased transfer of traumatic brain injury patients to specialist neurosurgical care.
Purpose of the Study:
- To critically assess the evidence underpinning NICE recommendations for neurosurgical transfer of head injury patients.
- To examine the current configuration of specialist neurosurgical services in the UK.
- To evaluate the implications of increasing patient transfers on service capacity and access.
Main Methods:
- A systematic literature review was performed, focusing on emergency neurosurgical care for adult head injuries within the UK.
- Included studies were analyzed for relevance to UK neurosurgical provision, bed occupancy, transfer times, and policies.
- The quality and applicability of evidence cited in NICE guidance were critically evaluated.
Main Results:
- Fifty-eight relevant papers were identified, with 51 focusing on neurosurgical care aspects like capacity and transfer policies.
- The evidence base cited by NICE for head injury patient transfer was found to be of variable quality.
- A significant portion of the reviewed research originated outside the UK, questioning its direct relevance to the NHS.
Conclusions:
- Existing UK regional neurosurgical units face inadequate capacity to meet current demand for traumatic brain injury care.
- Increasing patient transfers, as suggested by NICE, is likely to strain already limited resources and exacerbate capacity issues.
- A rise in transfers could potentially worsen access inequalities for other patient groups, including elective surgical patients, particularly in resource-limited areas.
Abstract:
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.