CHALICE head injury rule: an implementation study

Area of Science:

• Emergency Medicine
• Clinical Guidelines
• Health Economics

Background:

• Paediatric head injury is a frequent emergency department (ED) presentation.
• The 2007 National Institute for Health and Clinical Excellence (NICE) guidelines introduced paediatric head injury protocols based on the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) rule.
• The resource impact of these guidelines on EDs has not been previously studied.

Purpose of the Study:

• To assess the resource implications of applying the 2007 NICE head injury guideline to paediatric patients.
• To compare the number of computed tomography (CT) scans recommended by the 2007 guideline versus actual practice in a pre-guideline cohort.

Main Methods:

• Retrospective analysis of paediatric head injury patient records from before 2007.
• Application of the 2007 NICE guideline criteria to historical patient data.
• Comparison of guideline-recommended CT scans with scans performed in actual clinical practice.

Main Results:

• Strict application of a pre-existing 2003 guideline would have resulted in 6% of patients receiving a CT scan.
• Applying the 2007 guideline to the same cohort would have increased CT scans by 4.6% (21 additional scans).
• The estimated annual cost of extra CT scans (£3570) was offset by potential savings from reduced admissions (£10,450).

Conclusions:

• The 2007 guideline's impact on ED resources suggests a potential net cost saving despite an increase in CT scans.
• Consideration of neoplasia risks associated with increased CT scanning is warranted.
• Study limitations included a preference for admission over scanning and incomplete clinical data; a prospective study is suggested for further investigation.