Impact of regional imaging guidelines for head injury and unconscious polytrauma patients

Introduction

Inadequate or delayed imaging of the unconscious patient with traumatic brain injury or of the unconscious polytrauma patient may lead to catastrophic consequences. The need for comprehensive imaging needs to be balanced against the patient's condition, the resources available and excessive radiation exposure. We have introduced regional evidence-based guidelines in the Southwest region of the UK. The aim of these guidelines was to standardise practice, minimise delayed or missed diagnosis of serious injuries, facilitate treatment of associated injuries (such as head injuries) and to obviate the need for repeated imaging.

Methods

The notes of all unconscious polytrauma patients transferred from the emergency department or other hospitals and all patients transferred to our institution for ongoing neurosurgical care were retrospectively reviewed over a 1-year period. Adherence to the imaging protocol was assessed and the need for any further radiological investigations within 48 hours was also documented.

Results

A total of 46 patients were identified who fulfilled the criteria for the introduced guidelines. Of these patients, 21% were transferred from other hospitals while the remainder was admitted from the onsite emergency department. Eighty-three per cent of all eligible patients adhered to the protocol. Two patients (4%) required further radiological investigation in the 48 hours following admission. Both had isolated head injury and required further imaging to exclude cervical injuries following inadequate imaging which did not follow protocol. One further patient (2%) required repeated imaging to exclude mesenteric injury.

Conclusions

Regional adoption of imaging guidelines aimed at obtaining early comprehensive imaging of both head-injured and polytrauma patients results in high compliance and a low rate of re-imaging.