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Implementing the National Institute for Health and Clinical Excellence Head Injury 2014 Guidelines in a major children’s hospital emergency department

Ramjeeawon, Nataliea; Lecky, Fionab; Burke, Derek P.c; Ramlakhan, Shammic

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 158–162
doi: 10.1097/MEJ.0000000000000512
Original articles

Objectives and background Head injury is a common paediatric emergency department presentation. The National Institute for Health and Clinical Excellence updated its guidance in January 2014 regarding imaging required for adults and children following a head injury (CG176). This study looked at the rates of computed tomography (CT) head scans performed and adherence rates to CG176.

Patients and methods A single-centre audit was carried out, examining imaging practice in children with head injuries. CG176 was implemented formally in August 2014 to the new trainee doctors. The primary outcome was adherence to CG176. As the data were binary, 95% confidence intervals were used for comparison.

Results In all, 1797 patients were identified as having a head injury. Implementation at the Sheffield’s Children NHS Foundation Trust resulted in a statistically significant increase in guideline adherence from 79.2% [95% confidence interval (CI): 76.4–81.9%] to 85.1% (95% CI: 82.9–87.4%). The greatest impact in adherence was found in CT head scans, from 95.8% (95% CI: 94.5–97.2%) to 97.7% (95% CI: 96.7–98.6%).

Conclusion The implementation at the Sheffield’s Children NHS Foundation Trust was successful in satisfying the aim of CG176 by increasing adherence and decreasing CT head scans. This success could be explained by the formal implementation to the new cohort of doctors and better physician agreement with the guidelines. The increase in adherence is contrary to the previous studies.

aRoyal Sussex County Hospital, Brighton

bSchool of Health and Related Research, University of Sheffield

cEmergency Department, Sheffield Children’s NHS Foundation Trust, Sheffield Children’s Hospital, Sheffield, UK

Received 10 February 2017 Accepted 4 October 2017

Correspondence to Natalie Ramjeeawon, MBChB, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK Tel: +44 754 481 0010; fax: +44 127 362 6653; e-mail:

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