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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 August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Adult patients with head injury as their primary diagnosis. | Managment 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 % | 77 % | |||
| 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 % | 100 % |
Comments
Overall a good set of results, with improvements in most areas, which are now achieving the target. However, documentation of head injury advice on discharge has decreased, however this may just be a documentation issue.
Audit Bottom Line
Overall, and excellent set of results, and with some extra work around documentation, reach targets across each of the criteria is achievable. However care must be taken when generalising from these results due to the small sample size.