National Institute for Health and Clinical Excellence (NICE)
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Take head injuries seriously and treat quickly, says NICE

Children and adults who suffer a head injury should be taken straight to a hospital with resuscitation facilities to avoid potentially serious complications, including disability or death, says NICE.

Each year, it's thought almost one-and-a-half million people go to their local A&E department with a recently sustained head injury. Two hundred thousand are admitted to hospital with their injuries. Of these people, around one in five will have a serious head injury or brain damage. While most people recover, others can experience long-term disability or even die.

In an update to existing guidelines, NICE stresses the importance of early detection and prompt treatment for head injuries. Patients who have suffered a head injury but also begin to show particular signs that the injury may be serious or potentially life-threatening, such as seizures, fracture skull or loss of consciousness, should be given a CT brain scan within one hour.

Those presenting with a head injury and no additional risk factors should be given a CT head scan within four to eight hours of the injury. A provisional written radiology report should be made available within 1 hour of the scan being performed.

A hospital doctor or specialist who is trained in dealing with sensitive cases, such as potential abuse, should be involved in checking any patient with a head injury presenting to A&E, especially if it's a possible non-accidental injury or a vulnerable person has been injured.

NICE also recommends that doctors and nurses give verbal and printed advice to patients, with any type of head injury who are discharged from an emergency department or observation ward, and their families and carers. Any advice should be accessible and appropriate to the patient's age.

Fiona Lecky, Honorary Consultant in Emergency Medicine at the University of Sheffield and Chair of the Guideline Development Group, said: “Head injuries are the most common cause of death and disability in people up to the age of 40. How quickly a person receives treatment for their head injury can make all the difference to their life.

“New technology and techniques means the NHS is able to assess people more quickly and provide specialist care for patients with severe head injury more frequently. This updated guideline reflects the very best practice available, which I have no doubt will result in fewer people dying from their head injury.”

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Over the past year media attention has focused on several high profile names who have suffered potentially serious head injuries but waited several hours before seeking medical attention. These incidents should act as a warning that any head injury needs to be taken seriously and treated quickly: although a person may appear fine at first, it is not uncommon for symptoms of a head injury to affect them some hours after the trauma took place.

“This updated guidance will ensure the NHS has the necessary processes in place to diagnose and treat head injuries in a timely manner, which will play a major part in saving the lives of people who have suffered a serious blow to the head.”

Dr James Robson, National Team Doctor for the Scottish Rugby Union and head doctor during the British & Irish Lions tour to Australia last year, backs the updated guideline. He said: “The NICE 2014 guidelines on Head Injury are a welcome release at a time of unprecedented activity on this issue in sport both nationally and internationally.

“The guidelines should be a required read for all professionals involved in the management of Head Injury in the Pre- and Hospital settings; and in particular for myself and other colleagues, in the sporting arena.

“This document will form a reference source for evidence based assessment, and care, of some of our most vulnerable patients, and will add immense value to the debate, education, and research surrounding one of the most important issues of our time. The guidance on head injury triage, assessment, investigation, and early management should form the basis for the development of specific local protocols, ensuring that best practice and care is available to all, wherever their need may arise.

“We only have one head, let's use it not lose it.”

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