Helen Seeley1, Chris Maimaris2, Judith Allanson3, John Pickard4, Peter Hutchinson4. 1. Division of Academic Neurosurgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. 2. Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK. 3. Department of Neuroscience & Rehabilitation Clinic, Addenbrooke's Hospital, Cambridge, UK. 4. Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK.
Abstract
OBJECTIVES: To survey the attendance of patients presenting with a head injury (HI) at a UK emergency department (ED), identifying numbers, types of service and referral routes; to survey subsequent service use and to highlight the challenges in service planning and identifying which patients may potentially benefit from follow-up/rehabilitation input. DESIGN: A retrospective population-based case series study using multiple prospective and retrospective data sources. METHODS: Adults from the National Health Service (NHS) Cambridgeshire catchment area attending an ED over a 6-month period with a HI were identified from detailed ED reports, and any service use within the hospital after injury was tracked using a number of data sources. RESULTS: 1036 patients presented on 1081 occasions with a HI during the 6 months. Of the 1081 HIs, 979 (91%) were mild (Glasgow Coma Scale (GCS) score 13-15), 70 (6%) were moderate (GCS score 9-12), and 32 (3%) were severe (GCS score <9). A number of types of referral routes and systems were identified and analysed: 873 (81%) patients were discharged directly from ED, with four offered HI-specific follow-up. Of 208 admissions, 27 (2%) were to neurosurgical care, and 35 (3%) patients were offered HI-specific follow-up, 24 of these being in a specialist neurotrauma clinic. Follow-up started between 1 and 18 months after injury. At 24 months after injury, follow-up for 10 of these was still ongoing. CONCLUSIONS: These study findings highlight the difficulties in identifying patients who would benefit from follow-up, in particular after mild HI. Our study findings will form the basis of a long-term follow-up study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: To survey the attendance of patients presenting with a head injury (HI) at a UK emergency department (ED), identifying numbers, types of service and referral routes; to survey subsequent service use and to highlight the challenges in service planning and identifying which patients may potentially benefit from follow-up/rehabilitation input. DESIGN: A retrospective population-based case series study using multiple prospective and retrospective data sources. METHODS: Adults from the National Health Service (NHS) Cambridgeshire catchment area attending an ED over a 6-month period with a HI were identified from detailed ED reports, and any service use within the hospital after injury was tracked using a number of data sources. RESULTS: 1036 patients presented on 1081 occasions with a HI during the 6 months. Of the 1081 HIs, 979 (91%) were mild (Glasgow Coma Scale (GCS) score 13-15), 70 (6%) were moderate (GCS score 9-12), and 32 (3%) were severe (GCS score <9). A number of types of referral routes and systems were identified and analysed: 873 (81%) patients were discharged directly from ED, with four offered HI-specific follow-up. Of 208 admissions, 27 (2%) were to neurosurgical care, and 35 (3%) patients were offered HI-specific follow-up, 24 of these being in a specialist neurotrauma clinic. Follow-up started between 1 and 18 months after injury. At 24 months after injury, follow-up for 10 of these was still ongoing. CONCLUSIONS: These study findings highlight the difficulties in identifying patients who would benefit from follow-up, in particular after mild HI. Our study findings will form the basis of a long-term follow-up study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Trauma, head; emergency care systems, emergency departments; epidemiology
Authors: Petra Mäkelä; Fiona Jones; Maria Inês de Sousa de Abreu; Lucinda Hollinshead; John Ling Journal: Health Expect Date: 2019-04-29 Impact factor: 3.377