An evaluation of the effect that the implementation of the NICE rules may have on a diagnostic imaging department for the early management of head injuries

Abstract 

Introduction

Guidelines by the National Institute of Clinical Excellence (NICE) for the early management of minor head injuries initiate the use of computed tomography (CT) for patients who may be at risk of developing intracranial haematoma. This retrospective study was designed to evaluate the effect the implementation of the NICE guidelines would have on the diagnostic imaging department of a local district general hospital. The main objective was to establish if there would be an increase in the number of CT head referrals for patients with minor head injuries. Secondly to assess how the implementation of these guidelines would affect the workload to the diagnostic imaging department in terms of cost and time, and to discuss the issue of radiation dose to patients.

Method

A sample of 100 patients who were referred from the Accident and Emergency department (A&E) for plain skull radiographs, over a 4-month period were selected. The clinical information on each of these patients' was then extracted and a data collection sheet was to assess each patient according to the NICE criteria.

Results and conclusion

The study found an 18% (n=100) increase in the referral rate for CT heads for patients presenting with minor head injuries. It was also found that the use of these guidelines would mean a decrease in cost to the diagnostic imaging department of £324. Furthermore a saving of 10h of radiographers' time was established, although the effective radiation dose to patients would be increased by 29mSv.

The NICE guidelines have proved efficient in identifying patients with intracranial damage although this coincides with an 18% (n=100) increase in referral rates for CT and increased radiation dose to patients. However, the use of these guidelines would reduce workload to the diagnostic imaging department in terms of cost and time.

Keywords: Head injuries, Computed tomography, Radiography, Skull fractures