Introduction: Head injury is the commonest cause of death and disability in people aged 1–40 years in the UK. Annually 1.4 million people present to Hospital with a head injury in England and Wales, and 200,000 of these cases result in admission. Management of such patients must follow clear procedures in order to allow serious injuries to be readily identified and treated urgently in order to prevent disability and death.
The National Institute for Health and Care Excellence (NICE) head injury guidelines, 2014, state that the neurosurgical service should be consulted in “surgically significant” imaging abnormalities, a definition to be determined locally. Also, regardless of imaging, consultation should be sought for prolonged confusion, GCS deterioration, progressive deficit, seizures without full recovery, penetrating injury and CSF leak.
Methods: This was a retrospective review of 50 head injury referrals to neurosurgery, submitted online during a 2 month period in 2015 with the aim of determining how well the referral criteria were adhered to. The referrals were analysed and compared to the previous audit of 51 referrals, taken over the phone in 2014.
Results: 56% of the referrals made in 2015 were deemed “appropriate” according to the referral criteria. In 2014 however, 73% were classed as “appropriate”. 22% of the 2015 referrals resulted in admission to the neurosurgical service, whereas in 2014 only 13% of referrals resulted in specialist admission.
Conclusions: Unfortunately it appears that the introduction of the online referral system has resulted in poorer quality referrals as a lower percentage are now deemed “appropriate” according to the NICE criteria. The reason for this change needs to be determined in order to ensure referrals are made appropriately in the future however, it is clear more education on the guidelines is needed. The increased admission rate from the 2015 audit is interesting and also requires further examination.
Patient Care: This audit has highlighted the need for further research to identify best referral method for referring head injury patients. This will encourage prompt and appropriate head injury referrals, consequently reducing disability and death.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the referral guidelines in place for head injury referrals to neurosurgery in the UK
2) Appreciate the effect of online referral system on quality of referrals for head injury patients
References: The National Institute for Health and Care Excellence (NICE). 2014.Head injury: assessment and early management
NICE guidelines [CG176].[Online].[Accessed 15th March 2016]