An audit on guidelines used for the initial management of patients with minor head injuries in Denmark

The purpose of this quality assurance study was to compare the practice used in the management of patients with minor head injuries (MHI) in Denmark with guidelines recommended by Danish neurosurgeons and analyse differences between hospitals in the treatment of patients with MHI. All 68 accident and emergency departments in Denmark covering a population of 5,146,000 inhabitants and 895,000 attenders received a questionnaire containing questions about epidemiological data, the clinical practice and the use of skull x-ray. Ninety-four per cent of the hospitals responded. The number of patients admitted per 100,000 inhabitants per year was the same (mean 235) in large and small hospitals, but in the small hospitals significantly more patients per 100,000 attenders per year were admitted (p < 0.05). More than 80% of the hospitals recommended admission if the patient reported unconsciousness, significant headache, dizziness or nausea and vomiting. Symptoms found at the examination in the A & E department had high priority in the decision to admit patients in more than 90% of the hospitals. Skull x-ray was always used in only 2/64 hospitals. The compliance with guidelines give by Danish neurosurgeons was unsatisfactory as far as the symptoms in the history were concerned.