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An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury.

https://arctichealth.org/en/permalink/ahliterature125168
Source
Scand J Trauma Resusc Emerg Med. 2012;20:32
Publication Type
Article
Date
2012
Author
Ben Heskestad
Knut Waterloo
Tor Ingebrigtsen
Bertil Romner
Marianne Efskind Harr
Eirik Helseth
Author Affiliation
Department of Neurosurgery, Oslo University Hospital-Ullevål, Oslo, Norway.
Source
Scand J Trauma Resusc Emerg Med. 2012;20:32
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Craniocerebral Trauma - diagnosis - therapy
Diagnostic Imaging
Disease Management
Female
Guideline Adherence
Hospitals, University
Humans
Infant
Infant, Newborn
Male
Middle Aged
Norway
Practice Guidelines as Topic
Young Adult
Abstract
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
Notes
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PubMed ID
22510221 View in PubMed
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Guideline compliance in management of minimal, mild, and moderate head injury: high frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders.

https://arctichealth.org/en/permalink/ahliterature153692
Source
J Trauma. 2008 Dec;65(6):1309-13
Publication Type
Article
Date
Dec-2008
Author
Ben Heskestad
Roald Baardsen
Eirik Helseth
Tor Ingebrigtsen
Author Affiliation
Department of Neurosurgery, Ulleval University Hospital, Oslo, Norway. ben.heskestad@ulleval.no
Source
J Trauma. 2008 Dec;65(6):1309-13
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Algorithms
Brain Injuries - classification - radiography - therapy
Evidence-Based Medicine - statistics & numerical data
Glasgow Coma Scale
Guideline Adherence - statistics & numerical data
Hospitals, University
Humans
Norway
Practice Guidelines as Topic
Prospective Studies
Tomography, X-Ray Computed
Triage
Abstract
The evidence-based Scandinavian Guidelines for the Initial Management of Minimal, Mild, and Moderate Head Injuries were developed to provide safe and cost-effective assessment of patients. A survey based on a questionnaire directed to clinical managers in all Norwegian hospitals indicated that the guidelines had influenced management practice significantly. However, implementation of guidelines and compliance from clinical leaders does not necessarily influence individual physicians decisions making.
To evaluate physicians-compliance with the Scandinavian Guidelines in individual patients, we conducted a study (January 2003 to January 2004) that included all patients with minimal, mild, and moderate head injury who presented to the emergency department in a Norwegian university hospital. Guideline compliance was evaluated in the assessment and treatment of 508 patients. The management of each single patient was classified as compliant with the guidelines or not. Classification as compliant required correct use of computed tomography (CT) and hospital admission in accordance with the guideline.
The overall physicians-compliance with the Scandinavian Guidelines was 51%. A substantial overtriage with unnecessary CT examinations and hospital admissions was seen in patients with minimal and mild head injuries. Among patients with minimal head injury, 69% underwent overtriage, 18% with unnecessary hospital admission, 27% with unnecessary CT, and 24% with both. Among patients with mild head injury, 37% were subject to overtriage, all with admission for observation after a negative CT. All patients with moderate head injury were treated in accordance with the guideline.
Guidelines for assessment and treatment of minimal and mild head injuries may not have the intended degree of influence on clinical practice. Even in departments where clinical managers report that the practice is evidence based, physicians may not act in accordance with this in their daily practice. This causes significant unnecessary costs, estimated as USD 2,167.000 annually in Norway.
Notes
Comment In: J Trauma. 2009 Jul;67(1):217-819590343
PubMed ID
19077619 View in PubMed
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[Impact of Scandinavian guidelines on management of mild head injuries].

https://arctichealth.org/en/permalink/ahliterature169460
Source
Tidsskr Nor Laegeforen. 2006 Apr 27;126(9):1205-7
Publication Type
Article
Date
Apr-27-2006
Author
Kay Müller
Bertil Romner
Tor Ingebrigtsen
Knut Waterloo
Knut Wester
Author Affiliation
Nevrokirurgisk avdeling, Universitetssykehuset Nord-Norge, 9038 Tromsø. kay.muller@unn.no
Source
Tidsskr Nor Laegeforen. 2006 Apr 27;126(9):1205-7
Date
Apr-27-2006
Language
Norwegian
Publication Type
Article
Keywords
Craniocerebral Trauma - complications - diagnosis - therapy
Cross-Sectional Studies
Glasgow Coma Scale
Guideline Adherence
Humans
Norway
Physician's Practice Patterns
Practice Guidelines as Topic
Questionnaires
Risk factors
Scandinavia
Tomography, X-Ray Computed
Abstract
A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian guidelines for management of mild head injuries have been published.
A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance.
The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing patient consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be discharged from the emergency department increased (p
PubMed ID
16670742 View in PubMed
Less detail

Mild head injuries: impact of a national strategy for implementation of management guidelines.

https://arctichealth.org/en/permalink/ahliterature182375
Source
J Trauma. 2003 Dec;55(6):1029-34
Publication Type
Article
Date
Dec-2003
Author
Kay Müller
Knut Waterloo
Bertil Romner
Knut Wester
Tor Ingebrigtsen
Author Affiliation
Department of Neurosurgery, University Hospital of North Norway, University of Bergen.
Source
J Trauma. 2003 Dec;55(6):1029-34
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Algorithms
Craniocerebral Trauma - classification - complications - diagnosis - therapy
Cross-Sectional Studies
Decision Trees
Emergency Service, Hospital
Emergency Treatment - standards - statistics & numerical data
Evidence-Based Medicine
Glasgow Coma Scale
Guideline Adherence - standards - statistics & numerical data
Hospitals, Public
Humans
Information Dissemination - methods
National Health Programs
Norway
Patient Selection
Physician's Practice Patterns - standards - statistics & numerical data
Practice Guidelines as Topic
Program Evaluation
Quality Assurance, Health Care
Questionnaires
Risk factors
Tomography, X-Ray Computed
Unconsciousness - etiology
Abstract
A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published.
A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance.
The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing the patient's level of consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be sent home from the accident and emergency department increased (p
PubMed ID
14676646 View in PubMed
Less detail