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Compliance with NICE Guidelines 2014 for Traumatic Head Injury in regard to CT
EP39329
Poster Title: Compliance with NICE Guidelines 2014 for Traumatic Head Injury in regard to CT
Submitted on 27 Sep 2022
Author(s): Sarah Afify, Chryshane Fernandopulle, Hussein Kamel
Affiliations: Barts health NHS trust
This poster was presented at Local radiology meeting at Newham university hospital
Poster Views: 213
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Poster Information
Abstract: Abstract: Background

Head Injury is defined as trauma of head apart face. About 1.4 million people present to ED every year. As a result, National Institute of Health & Clinical Excellence formulated clear guidelines (CG176) for accessing and performing CT Imaging. This study evaluates whether patients are accessed and performed CT Imaging according to NICE guidelines.

Methods

A retrospective study was carried out in the radiology department with suspected head injury patients during the period from January till the end of February 2021.

Data were harvested from RIS and PACS using the following criteria:
(Modality was used as CT head including those who did the CT head as part of whole body trauma series)

Inclusion Criteria:
1- Patient who sustained trauma of any kind to their head.
2- CT head done within the period from 1/1/2021 to 28/2/2021, including these done along with CT cervical spine, CT facial and CT whole body trauma scans

Exclusion criteria:
1- Unsure history about trauma to the head.
2- Scans with artefacts affecting the image quality.
We have not excluded pediatric patients but we did not encounter any of them during our inclusion period.


Results:

Compliance with the guidelines was limited during the period investigated at NUH
94 out of 168 were non complaint with the NICE guidelines (55.9%) due to indications.
31 scans were indicated as trauma only with no additional history.                   
 29 scans were indicated as scalp or facial swelling with no additional history.                   
16 scans were indicated as confusion or headache.
16 scans (9.5%) were supposed to be done within 1 hour from the request according to the guidelines , 4 of them were delayed due to terminal cleaning after a COVID patient , 3 were delayed due to in co-operation of the patient, the rest were due to delayed sending the patients from AE or wards for not documented reasons.
1 scan was supposed to be done within 8 hours but was delayed to 9 hours due to delayed sending of the patient from AE.
14 scans(8.3%), their reports were delivered more than 1 hour, 3 of which were whole body imaging . 
113 out of 168 (67%) scans were normal scans  
45 scans ( 26.7%) had scalp hematoma or facial injuries    
Only one scan had significant intracranial bleeding in the form of EDH     
9 scans were whole body scans, they did not sustain any intracranial injury


Conclusions:

This retrospective study signifies the understanding of doctors in managing Head Injury To achieve further Compliance and quality of documentations certain implementations have been brought in action

-Spread the awareness about the NICE guidelines in the AE, radiology department and different wards through meetings and emails.
-If possible, to add the guidelines to the system where requests for CT head are submitted.
The following criteria should be met in every submitted request
1.       If the CT head request is in keeping with NICE guidelines, request CT and speak to CT radiographers to arrange a time for CT. No need to be vetted by the duty Radiologist, except paediatric head trauma and body trauma.
2.       Short description of the mechanism and the side of injury. (eg- side of impact/scalp haematoma/laceration) should be mentioned in the request.
3. GCS value should be used instead of the more vague terms as confusion.
4. when submitting the request, mention whether it should be done within 1 hour or 8 hours according to the guidelines.


With these potential implementations and successive evaluation will seek to achieve 100% compliance and documentation ensuring appropriate imaging in a cost- and resource-effective manner while preventing unnecessary radiations.
Summary: This study is about the evaluation of performance in the radiology department in the management of Head Injury with the national recommended guidelines,References: National Institute for Health and Care Excellence (2017) Head injury: assessment and early management. NICE guidelines (CG176).Report abuse »
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