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Adult Minor Head Injury CPI
Clinical scenario
Every year approximately 2 million people in the UK sustain a head injury. For many years there has controversy over the investigation and management of these patients. Since the advent of the NICE guidance and increased availability of CT scanning, there has been a dramatic reduction in the number of skull Xrays requested.
Audit question
Are adult minor head injury patients managed appropriately according to best practice (NICE) guidelines?
Method
Retrospective audit 50 consecutive Emergency Department patient records
Criteria
Inclusions: 50 adults coded as minor head injury
Exclusions: Exclude patients presenting GCS <15
Audits
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1st December 2007
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2007 | Adult patients with head injury as their primary diagnosis. | Management of patients according to the criteria. | Documented evidence of GCS | 100 % | 100 % |
| Documented evidence of presence or absence of history of loss of consciousness, amnesia and vomiting (all three required). | 100 % | 100 % | |||
| Documented evidence of assessment of bleeding risk (use of anticoagulation etc). | 100 % | 100 % | |||
| Documented mechanism of injury | 100 % | 100 % | |||
| Documented evidence of receiving head injury advice on discharge | 100 % | 76 % |
Comments
Significant improvement noted in nearly all aspects of patient care, achieving 100% in all but one criteria. The exception being intubation within target of 15 minutes of arrival for serious head injury, where the score dropped from 100% to 76%.
Audit Bottom Line
Excellent improvement overall. However investigation recommended into intubation target for serious head injuries.