A national audit of head injury discharge advice

Head injury is a common presentation to emergency departments, and most patients are discharged with a diagnosis of concussion. Written discharge advice provided to patients serves as a critical tool to communicate signs of surgical deterioration and to convey management principles to reduce long-term morbidity associated with concussion. This study aimed to evaluate the compliance of head injury discharge leaflets with National Institute for Health and Care Excellence (NICE) guidance.

A cross-sectional, national audit of practice was conducted to assess the adherence of head injury discharge leaflets to NICE head injury guidelines (NG232) across all eligible NHS England trusts. Compliance against each domain was evaluated in duplicate against a standardised, piloted proforma, with overall quality summarised as an average score. Exploratory analysis between domains was performed, with comparative analysis between leaflets for adult and paediatric patients.

None of the 99 leaflets reviewed (0/99) complied with all aspects of NICE guidance. The mean score of the leaflets was 0.42 out of 1, falling short of the set target of 0.95. There was no significant difference in mean scores between adult and paediatric leaflets. Safety information based on surgically-relevant deterioration achieved the compliance target of 95%. Advice on concussion management (including symptoms to expect, return to normal activities, and the details about further support and information in case of persistent symptoms) was generally poor. Additionally, 50.5% (50/99) of leaflets advised against returning to activities 'until feeling completely back to normal', which contradicts current guidance. The quality of head injury discharge leaflets currently does not meet satisfactory standards. A centrally curated, regularly updated discharge leaflet, with provision for local modifications, is recommended to standardise practice based on current specialist practice. This is a cost-effective intervention which has considerable potential to improve outcomes after head injury.