The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention.
We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline.
The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p
According to a questionnaire of 830 patients and 153 neurologists, both a timely asking for medical care and a timely treatment at specialized neurology hospitals are the key factor that cuts the rate of complications in craniocerebral trauma. Finally, a differential approach to treatment schemes with due respect to a trauma severity, availability of rehabilitation centers and application of new medical technologies, e.g. cranio-sacral therapy, are equally important.
An analysis of 658 medical records of inpatient treatment from 15 hospitals of St.Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52.9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1.0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1.0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma.
Evidence-based protocols exist for Emergency Department (ED) patients diagnosed with minor head injury. These protocols focus on the need for acute intervention or in-hospital management. The frequency and nature of concussive symptoms experienced by patients discharged from the ED are not well understood.
To examine the prevalence and nature of concussive symptoms, up to 1 month post-presentation, among ED patients diagnosed with minor head injury.
Eligible and consenting patients presenting to Kingston EDs with minor head injury (n = 94) were recruited for study. The Rivermead Post-Concussion Symptoms Questionnaire was administered at baseline and at 1 month post-injury to assess concussive symptoms. This analysis focused upon acute and ongoing symptoms.
Proportions of patients reporting concussive symptoms were 68/94 (72%) at baseline and 59/94 (63%) at follow-up. Seventeen percent of patients (18/102) were investigated with computed tomography scanning during their ED encounter. The prevalence of somatic symptoms declined between baseline and follow-up, whereas some cognitive and emotional symptoms persisted.
The majority of patients who present to the ED with minor head injuries suffer from concussive symptoms that do not resolve quickly. This information should be incorporated into discharge planning for these patients.
Regionalized approaches to trauma care improve patient outcomes. We developed and distributed a clinical reference poster to standardize the emergency department evaluation and management of patients with traumatic head injuries in hospitals throughout Nova Scotia.
We conducted a MEDLINE literature search to identify publications in the fields of prehospital and emergency management of head injuries. We reviewed and collated select studies to define contemporary standards of care.
We derived a 3-tiered decision tool that summarizes the indications for resuscitation, radiography, specialty consultation and transfer of adult and pediatric patients with minor and major head injuries. A guideline poster was constructed and distributed to all provincial emergency departments upon approval by local trauma and critical care staff.
This report describes the evidence for a population-based, province-wide assessment and early management tool that was developed for health care personnel who treat patients with head traumas. Comparison of outcome data from pre- and postguideline eras will ultimately shed light on the use of regionalized approaches to managing brain injuries.
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