Fairly lukewarm. (And this is a hospital with the easiest access to CT scans
that I have ever worked in) Our head injury protocol (based on the Canadian
CT scan rules) seems to have increased the admission rate substantially, but
not increased the rate of scans. This is because we gave the radiologists a
'get out clause' that minor heads that presented after 8pm could be observed
on our obs ward. Guess when most head injuries present?
I have real misgivings about the way NICE has swallowed the Canadian CT head
rule, hook, line and sinker. The Canadian CT head rules were designed to
reduce the amount of CT scans performed for minor head injuries (and
probably does in North America). We estimate that applying the Canadian CT
head rule in the UK will increase the number of CT scans performed by about
75% compared to the RCS guidelines. There is some interesting correspondence
in Clinical Radiology 2002:57 152-153, which makes the entirely reasonable
point that our existing RCS guidelines are so good at detecting
intra-cranial haemotomas (a missed treatable haematoma rate of less than 1
in 10,000) that any new guideline is unlikely to show much of an benefit.
I think the next challenge in this field is to show that is completely safe
to discharge somebody after a normal CT scan who is orientated. Until then
we cannot really justify or (afford?) these guidelines.
Adrian
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Andrew Webster
Sent: Friday, August 15, 2003 6:16 PM
To: [log in to unmask]
Subject: NICE head injury guidelines
What has been the reaction of your local radiologists to the recent
publication of the NICE guidelines?
Has access to CT scanning improved? and have you seen a reduction in the
number of skull x-rays requested?
Andy Webster
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