Hospital admissions with head injury following publication of NICE guidance

Background: A recent update suggested that the National Institute for Health and Clinical Excellence (NICE) guidance on head injury had led to safe early discharge, evidence of a reduction in the numbers of admitted patients and cost savings in some centres. The aim of this study was to use national Hospital Episodes Statistics (HES) data to determine whether admissions with head injury have changed since the NICE guidance was introduced. Methods: HES data coded as S00-S09 Injuries to the head'' from 1998-9 to 2006-7 were examined for admissions, age and length of stay. Results: Admissions rates did not change markedly until 2003 when the NICE head injury guidelines were issued. From 2003, admissions increased for all adult age groups but not for children. Mean length of stay remained constant between 1998 and 2007, so bed days increased in proportion to admission rates. Conclusion: Adult head injury admissions in England have increased markedly since the introduction of the NICE guidelines. Given that there is little evidence that hospital admission is beneficial for patients with minor head injury, NICE head injury guidance appears to have failed to promote cost effective care.