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Are we following the guiding SIGN when managing paediatric head injury?
I C Coulter1, P M Brennan, G Duthie
1Department of Paediatric Surgery, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, UK. ian.coulter@doctors.org.uk
Insights
Paediatric head injury management in this unit relies on clinical judgment over Scottish Intercollegiate Guidelines Network (SIGN) recommendations. Adherence to SIGN guidelines for imaging, neurosurgical review, and follow-up in children with head injuries needs improvement.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Clinical Auditing
Background:
- The Scottish Intercollegiate Guidelines Network (SIGN) provides guidelines for managing pediatric head injuries.
- Auditing current practice against SIGN recommendations is crucial for ensuring optimal patient care.
Purpose of the Study:
- To audit the management of pediatric head injuries in a local unit.
- To assess adherence to SIGN guidelines for imaging, neurosurgical review, and follow-up.
Main Methods:
- Retrospective data collection from 200 pediatric patient records admitted in 2007.
- Audit against two versions of the SIGN guideline: Guideline 46 (2000) and Guideline 110 (2009).
Main Results:
- Computed Tomography (CT) scans were underutilized compared to both SIGN guidelines (16% vs. 146 indicated for Guideline 46; 50% and 21% vs. indicated/considered for Guideline 110).
- Neurosurgical review was sought in only 31% of indicated cases.
- Follow-up was arranged for only 28% of patients with significant head injuries.
Conclusions:
- Management decisions regarding imaging, neurosurgical consultation, and follow-up for pediatric head injuries in this unit are primarily based on clinical judgment, not SIGN guidelines.
- Further research is recommended to explore the impact of increased guideline awareness and adherence on clinical outcomes.
Background And Aims:
The Scottish Intercollegiate Guidelines Network (SIGN) has published guidelines for the management of children with head injuries. The management of children with head injuries admitted to our local unit under the Paediatric Surgeons has been audited to determine whether or not current practice follows SIGN recommendations.
Methods:
Data were collected retrospectively from the case records of patients admitted between January and December 2007. The SIGN guideline 'Early Management of Patients with a Head Injury' (Guideline 46) was published in 2000 and updated in 2009 (Guideline 110). Head injury admission practices were audited against both guidelines.
Results:
The case records of 200 patients were analysed. According to SIGN Guideline 46 (2000), 146 Computed Tomography (CT) scans were indicated but only 24 were performed (16%). The updated Guideline 110 (2009) suggests a CT scan was indicated in 24 patients and should have been considered in a further 87. However, only 12 (50%) and 18 (21%) patients were imaged in these respective groups. Both guidelines indicated neurosurgical review in 13 patients but sought in only 4 (31%). 50 patients were deemed to have suffered a significant head injury warranting follow-up, but this was arranged in only 14 (28%).
Conclusions:
Our study has identified that management of paediatric head injuries in our unit is reliant on clinical acumen rather than the SIGN guidelines when making decisions regarding the need for imaging, neurosurgical review and follow-up. We suggest further investigation is required to determine whether greater awareness and closer adherence with the guidelines would alter clinical outcomes.
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