Implementing the National Institute for Health and Clinical Excellence Head Injury 2014 Guidelines in a major children’s hospital emergency department

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Abstract

Objectives and background

Head injury is a common paediatric emergency department presentation. The National Institute for Health and Clinical Excellence updated its guidance in January 2014 regarding imaging required for adults and children following a head injury (CG176). This study looked at the rates of computed tomography (CT) head scans performed and adherence rates to CG176.

Patients and methods

A single-centre audit was carried out, examining imaging practice in children with head injuries. CG176 was implemented formally in August 2014 to the new trainee doctors. The primary outcome was adherence to CG176. As the data were binary, 95% confidence intervals were used for comparison.

Results

In all, 1797 patients were identified as having a head injury. Implementation at the Sheffield’s Children NHS Foundation Trust resulted in a statistically significant increase in guideline adherence from 79.2% [95% confidence interval (CI): 76.4–81.9%] to 85.1% (95% CI: 82.9–87.4%). The greatest impact in adherence was found in CT head scans, from 95.8% (95% CI: 94.5–97.2%) to 97.7% (95% CI: 96.7–98.6%).

Conclusion

The implementation at the Sheffield’s Children NHS Foundation Trust was successful in satisfying the aim of CG176 by increasing adherence and decreasing CT head scans. This success could be explained by the formal implementation to the new cohort of doctors and better physician agreement with the guidelines. The increase in adherence is contrary to the previous studies.

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