Management of traumatic head injuries in a rural Irish hospital: implications of the NICE guidelines

The NICE guidelines were published in 2003 in an effort to standardise the management of traumatic head injuries, and advise a CT brain in certain situations. To evaluate the influence of the NICE guidelines on the management of head injuries in a county hospital. Complete clinical data were obtained for all patients with traumatic head injuries attending the ED of a county hospital from 2001 to 2005. Symptoms, examination details and outcome data were made available. The influence of the NICE guidelines on their management was then evaluated. Application of the NICE guidelines to these patients would have resulted in a 56% increase in the rate of CT brains being performed. No patient who did not have a CT brain had an adverse outcome. It is possible with limited resources and normal neurological observations that patients over the age of 65 can be managed safely.