Skip to main content

Advertisement

SpringerLink
Log in

An audit on guidelines used for the initial management of patients with minor head injuries in Denmark

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The purpose of this quality assurance study was to compare the practice used in the management of patients with minor head injuries (MHI) in Denmark with guidelines recommended by Danish neurosurgeons and analyse differences between hospitals in the treatment of patients with MHI. All 68 accident and emergency departments in Denmark covering a population of 5.146.000 inhabitants and 895.000 attenders received a questionnaire containing questions about epidemiological data, the clinical practice and the use of skull x-ray.

Ninety-four per cent of the hospitals responded. The number of patients admitted per 100.000 inhabitants per year was the same (mean 235) in large and small hospitals, but in the small hospitals significantly more patients per 100.000 attenders per year were admitted (p < 0.05). More than 80% of the hospitals recommeded admission if the patient reponed unconsciousness, significant headache, dizziness or nausea and vomiting. Symptoms found at the examination in the A & E department had high priority in the decision to admit patients in more than 90% of the hospitals. Skull x-ray was always used in only 2/64 hospitals.

The compliance with guidelines give by Danish neurosurgeons was unsatisfactory as far as the symptoms in the history were concerned.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. (1981) Costs and benefits of skull radiography for head injury. A national study by the Royal College of Radiologists. Lancet 2: 791–795

  2. (1984) Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons. BMJ 288: 983–985

  3. (1992) Guidelines for doctors in the new world. Lancet 339: 1197–1198

  4. Brown AFT, Wilkes GJ, Myers CT (1993) Use of an accident and emergency department observation ward in the management of head injury. Br J Surg 80: 1079

    Google Scholar 

  5. Central Bureau of Statistics (1992) Statistical Yearbook 1992, Central Bureau of Statistics, Copenhagen

    Google Scholar 

  6. Duus BR, Boesen T, Kruse KV, Nielsen KB (1993) Prognostic signs in the evaluation of patients with minor head injury. Br J Surg 80: 988–991

    PubMed  Google Scholar 

  7. Duus BR, Kruse KV, Nielsen KB, Boesen T (1991) Minor head injuries in a Copenhagen district. 1. Epidemiology. Ugeskr Laeger 153: 2111–2113

    PubMed  Google Scholar 

  8. Duus BR, Lind B, Christensen H, Nielsen OA (1994) The role of neuroimaging in the initial management of patients with minor head injury. Ann Emerg Med 23: 1279–1283

    PubMed  Google Scholar 

  9. Farmer A (1993) Medical practice guidelines: lessons from the United States. BMJ 307: 313–314

    PubMed  Google Scholar 

  10. Fowkers FG, Ennis WP, Evans RC, Roberts CJ, Williams LA (1986) Admission guidelines for head injuries: variance with clinical practice in accident and emergency units in the UK. Br J Surg 73: 891–893

    PubMed  Google Scholar 

  11. Gjerris F, Rosenorn J (1991) Diagnostik og behandling af patienter med lettere hovedtraumer. Ugeskr Laeger 153: 2101–2102

    PubMed  Google Scholar 

  12. Hackney DB (1991) Skull radiography in the evaluation of acute head trauma: a survey of current practice. Radiology 181: 711–714

    PubMed  Google Scholar 

  13. Haines A, Feder G (1992) Guidance on guidelines. BMJ 305: 785–786

    PubMed  Google Scholar 

  14. Hansen E (1971) Krainie-hjernelæsioner. Ugeskr Laeger 133: 893–894

    PubMed  Google Scholar 

  15. Harad FT, Kerstein MD (1992) Inadequacy of bedside clinical indicators in idehtifying significant intracranial injury in trauma patients. J Trauma 32: 359–361

    PubMed  Google Scholar 

  16. Jennett B (1989) Some international comparisons. In: Levin HS,et al (eds) Mild head injury. Oxford University Press, New York, pp 23–34

    Google Scholar 

  17. Jones JJ, Jeffreys RV (1983) Head injury patients admitted to general hospitals in Merseyside. Injury 14: 483–488

    PubMed  Google Scholar 

  18. Klauber MR, Marshall LF, Luerssen T, Frankowski R, Tabaddor K, Eisenberg HM (1989) Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 24: 31–36

    Google Scholar 

  19. Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah JW (1989) Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med 321: 1306–1311

    PubMed  Google Scholar 

  20. Madhok R, Thomson RG, Mordue A, Mendelow AD, Barker J (1993) An audit of distribution and use of guidelines for management of head injury. Qual Health Care 2: 27–30

    PubMed  Google Scholar 

  21. Masters SI, McClean PM, Arcarese JS, Brown RF, Campbell JA, Freed HA, Hess GH, Hoff JT, Kobrine A, Koziol DF,et al (1987) Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med 316: 84–91

    PubMed  Google Scholar 

  22. Miller JD (1991) Changing patterns in acute management of head injury. J Neurol Sci 103 [Suppl]: S33-S37

    PubMed  Google Scholar 

  23. National Board of Health (1992) The activity in hospilals 1990. Hospitalstatistics II:53:1192, The Danish Board of Health, Copenhagen

    Google Scholar 

  24. Rosenorn J, Duus B, Nielsen K, Kruse K, Boesen T (1991) Is a skull X-ray necessary after milder head trauma? Br J Neurosurg 5: 135–139

    PubMed  Google Scholar 

  25. Royal College of Radiologists Working Party (1992) Influence of the Royal College of Radiologists guidelines on hospital practice: a multicentre study. BMJ 304: 740–743

    Google Scholar 

  26. Stein SC, Ross SE (1993) Minor head injury: a proposed stralegy for emergency managemenl. Ann Emerg Med 22: 1193–1196

    PubMed  Google Scholar 

  27. Teasdale GM, Murray G, Anderson E, Mendelow AD, MacMillan R, Jennet B, Brookes M (1990) Risks of acute traumatic intracranial haematoma in children and adults. implication for managing head injuries. BMJ 300: 363–367

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark

    B. R. Duus M.D.

Authors
  1. B. R. Duus M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duus, B.R. An audit on guidelines used for the initial management of patients with minor head injuries in Denmark. Acta neurochir 139, 743–748 (1997). https://doi.org/10.1007/BF01420047

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01420047

Keywords

Search

Navigation