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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 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2008 | Adult patients with head injury as their primary diagnosis. | Management of patients according to the criteria | Documented evidence of GCS | 100 % | 87 % |
| Documented evidence of presence or absence of history of loss of consciousness, amnesia and vomiting (all three required). | 100 % | 94 % | |||
| Documented evidence of assessment of bleeding risk (use of anticoagulation etc). | 100 % | 86 % | |||
| Documented mechanism of injury | 100 % | 100 % | |||
| Documented evidence of receiving head injury advice on discharge | 100 % | 88 % |
Comments
Overall a disappointing set of results with 3 of the criteria which had previously improved significantly to reach target, now no longer reaching target. With the exception of documentation of head injury advice on discharge, which has improved nearly 20%, and cervical spine immobilisation, which continues to achieve target.
Audit Bottom Line
Work required around the use of CT, and timely intubation in appropriate patients.