Introduction
Head injury, a common presentation to the emergency department (ED), is a substantial problem in developing countries like Nepal. The current national institute for health and clinical excellence (NICE) guideline revised in January 2014 focuses on effective clinical assessment and early management of head injuries according to their severity in all age groups. This study assessed the impact of implementing this guideline on the proportions of computed tomography (CT) head scans, guideline adherence, and confidence level of the attending physicians.
Methods
We consecutively recruited 139 traumatic head injury (THI) patients in this prospective pre-post interventional study conducted in the ED of a tertiary care center. We implemented the NICE guideline into routine practice using multimodal intervention through physicians’ education sessions, information sheets and guideline-dissemination. The pre and post-implementation CT head scan rates were compared. The post-implementation guideline adherence was assessed. Online Google form-questionnaires including 12 validated case scenarios were distributed to the attending physicians at the end of both phases to assess their confidence levels.
Results
The implementation resulted in a statistically significant decrease in the proportion of CT head scan rates from 92.0% to 70.0% (p-value = 0.005). Following educational interventions, improved guideline adherence of 20.3 percentage points (p-value = 0.001) was observed. Nine ED attending physicians were enrolled in the study who showed statistically significant improvement in their confidence level following the intervention. The NICE guideline showed a sensitivity and specificity of 93.6% and 76.4% with 82.6% accuracy compared to that of clinical judgment (100%, 34.6%, and 58.1% respectively) in detecting intracranial lesions.
Conclusion
The implementation was successful in satisfying the aim of the NICE guideline by decreasing the proportion of CT head scans, improving guideline adherence and increasing the confidence of the attending physicians.
Introduction Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal.
MethodsThis is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS).
ResultsThe study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome.
ConclusionThis study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome.
A Study to Correlate Ocular Manifestations of Closed Head Injury with Glasgow Coma Scale and Vision and Neurological Outcome in A Rural Tertiary Care Center