Policies on the management of patients with head injury: the experience of Oxford Region

Abstract

Policies on the management of head injury are being discussed widely. This article draws upon experience in the Oxford Region and discusses policies covering all aspects of the management of head injury from prevention to long-term care. The main recommendations are as follows. 1) Health Authorities should promote prevention as far as possible. 2) Each Health Authority should have a policy on the emergency management of patients with severe trauma, stressing the management of head injury. 3) Each casualty department should have written policies covering: - the use of skull X-rays; - who should be admitted; - who needs urgent CT-scans and referral to neurosurgery: - preparation of patients for transfer to neurosurgery. 4) All adult patients with head injury should be admitted to a specialized ward which has written policies covering: - observations to be made AND actions to be taken; - discharge and follow-up; — referral to District neurological disability team; - referral to Regional rehabilitation centre; — management of behaviourally disturbed patients. 5) Most rehabilitation should be the responsibility of a District disability service specialized in neurological disability, but there should be a Regional centre for patients with unusual or severe disabilities. 6) There should be a named consultant in each District responsible for: — clinical management of patients with moderate to severe disability; - formulating and monitoring District policies for head injury. 7) Districts and Regions should consider how to manage patients: -with severe acute behavioural problems, especially aggression; -with long-term behavioural or cognitive problems. 8) Paediatric services for head injury should receive similar attention, with additional emphasis on liaison with schools. 9) Education of all staff should be a very high priority. 10) Close liaison and co-operation with all other agencies is essential.