724 Head Injuries in Children: Is it Nice to Ct Scan?

Abstract

Introduction: Trauma is commonest cause of hospital admission in children and head injuries account for 75% of children admitted. Head injury is a common cause of acquired neurological and cognitive disability in childhood. Indications for CT scan in children with head injury are well documented in NICE Guidelines, UK.Aim: To evaluate our practice for children attending A&E department with head injury at district general hospital in comparison with NICE guidelines.Method: This was a retrospective audit of case notes of children over a 2months period, attending the emergency department with head injury. Case notes were analysed to record Glasgow coma scale, children admitted for neurology observation and whether the NICE guidelines for CT scan was followed.Results: Of 120 children with head injury who attended A&E, 107 full case notes were available. In total 13/107 children (12%) met the criteria for CT scan. However 6/13 children (46%) were sent home after clinical assessment by a doctor. 7/13 (54%) were admitted for 24 hours neurology observation of which 3/13 underwent CT scan. Head injury leaflet was given to all children sent home.Conclusions: This study reiterates continual awareness of NICE guidelines amongst physicians for highest quality care. However as evident in this study, it may require a four fold increase in the number of CT scans done. This may not be possible at a district general hospital due to local constraints of radiology and can be circumvented by proper clinical assessment and follow up with a head injury advice booklet