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The management of minor head trauma (GCS 15-13) across a Trauma Network
Heinke Pülhorn1, Leann Westmoreland1, Catherine McMahon1
1a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK.
Insights
Management of minor head injuries varies significantly across trauma networks, with many lacking protocols and standardized follow-up. Neurosurgical centers should lead in developing network-wide guidelines for optimal patient care and staff education.
Area of Science:
- Trauma Surgery
- Neuroscience
- Healthcare Management
Background:
- Minor head injuries are common, presenting a challenge for consistent patient management.
- Variations in care pathways can impact patient outcomes and resource utilization.
Purpose of the Study:
- To assess the current practices and identify variations in managing patients with minor head injuries across a trauma network.
- To highlight areas for improvement in protocol development and patient follow-up.
Main Methods:
- An 18-point questionnaire was distributed to 19 wards in 10 trauma units.
- The survey covered hospital care and follow-up procedures for minor head injury patients.
Main Results:
- 58% of wards lack a management protocol for minor head injuries.
- Only 26% provide local follow-up, and 16% refer to specialist neurotrauma clinics.
- 74% of staff feel confident, but all units desire further education.
Conclusions:
- Standardized, protocol-based management of minor head injuries is crucial across trauma networks.
- Neurosurgical units in Major Trauma Centres should lead the development and implementation of these protocols.
- Enhanced staff education and professional development are essential for optimizing care.
Objectives:
To determine the variations in the management of patients with minor head injuries across a Trauma Network.
Methods:
An 18-point questionnaire covering aspects of hospital care and follow-up of patients with minor head injuries was sent out to 19 wards in 10 different trauma units within our network.
Results:
Fifty-eight percent of wards routinely admitting patients with minor head injuries have no management protocol in place. Mild head injury patients stay for 24-48 h as in-patients. Fifty percent of wards use GCS as the only assessment tool. Seventy-four percent of wards give post-head injury advice to their discharged patients with mild head injuries, but only 26% follow their patients up locally and 16% refer minor head injury patients to the specialist neurotrauma clinic. Twenty one percent of wards give information to their head injury patients regarding supporting organisations and charities. Seventy-four percent of ward staff report being confident in looking after head injury patients. All wards would welcome a head injury study day or an in-house education event.
Conclusion:
Management of minor head injury patients in trauma units should be standardised and neurosurgical units within Major Trauma Centres (MTC) need to lead in protocol based management of these patients across their network. NICE currently provide guidance detailing local management of head injuries not requiring immediate admission to the MTC. We believe it is the role of the neurosurgical centre to work with trauma units and provide guidelines and standards of practice to ensure optimal management of this vulnerable population group. In addition, the neuroscience centre has a role in ensuring staff education and on-going professional development across Trauma Networks.
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