Hospital facilities for head injured children: UK national survey
Rosie Houston1, Gale A Pearson
1Centre for Maternal and Child Enquiries (CMACE), Chiltern Court, 188 Baker Street, London NW1 5SD, UK. rosie.houston@yahoo.co.uk
Insights
Most children with head injuries attend emergency departments (EDs) at hospitals without on-site critical care. This highlights significant variations in pediatric head injury care across the UK.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care Systems
- Healthcare Services Research
Background:
- Child emergency department (ED) attendances and the organization of care for pediatric head injuries vary significantly across healthcare facilities.
- Understanding the distribution of pediatric emergency care and specialized services is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the distribution of child emergency department attendances across hospitals in England, Wales, and Northern Ireland.
- To assess the organizational structures for managing children with head injuries in these hospitals.
Main Methods:
- A cross-sectional survey was conducted from September 2009 to April 2010, encompassing 245 hospitals in England, Wales, Northern Ireland, and Crown Dependencies.
- The survey collected data on hospital services, ED activity, imaging, admission/discharge protocols, referral pathways, documentation, training, audit practices, information provision, and non-accidental head injuries.
Main Results:
- Only 64% of hospitals reported having an established pathway for managing head-injured children.
- A significant majority (82%) of child ED attendances occur at hospitals lacking on-site intensive care capabilities for critically ill children.
- Hospitals with on-site critical care for children were more likely to have specialized pediatric staff in the ED and access to broader surgical support.
Conclusions:
- Considerable variation exists in the facilities and services available for pediatric head injury management across different hospitals.
- Further comparative studies, including confidential inquiries, are warranted to investigate the standards of care and patient outcomes for head-injured children.
Aim:
To assess how child emergency department (ED) attendances are distributed between hospitals across England, Wales and Northern Ireland and how care is organised for children with a head injury.
Methods:
A cross-sectional survey was performed of the 245 hospitals in England Wales, Northern Ireland and the Crown Dependencies (Channel Islands and Isle of Man) which were eligible to participate in the enquiry from September 2009 to April 2010. The survey covered hospital details, departments and procedures, ED activity, imaging, admission and discharge procedures, referral and transfer, documentation, training and audit, information and advice, and non-accidental head injuries.
Results:
64% of hospitals have an established pathway for management of head injured children. Not infrequently hospitals asserting designation as specialist trauma or specialist neurosurgical centres do not offer an intensive care service for children. 82% of child ED attendances are to hospitals that would not care for a critically ill child on-site. Hospitals that do offer such care are much more likely to have children's trained staff available in the ED. They are also more likely to have access to surgical support beyond neurosurgery.
Conclusion:
Given the extent of variation between hospitals in the facilities available for head injured children, further comparative studies into the standards of care delivered and outcomes (including a confidential enquiry) are indicated.
