Care of head injuries falls well short of recommendations

September 16, 2001

Care of patients with head injuries falls well short of recommendations published two years ago, show two studies in Emergency Medicine Journal.

Audits of the whole of the Eastern Region of England and over 200 accident and emergency (A&E) departments in Great Britain and Northern Ireland, pinpoint major deficiencies in funding, staff, and service provision. The findings also show that levels of care vary considerably, and that rehabilitation and follow up of head injured patients are poor.

The Royal College of Surgeons issued a major report in June 1999 on the care of patients with head injury. This was followed by a further report from the Society of British Neurological Surgeons in February of last year.

The Eastern Region audit covered 20 acute hospital trusts plus the regional neurosurgical units at Addenbrooke's Hospital, serving nine of the 10 district hospitals, and Oldchurch Hospital, serving six district general hospitals. The nationwide audit of A&E departments obtained responses from 206 out of a possible 256.

Only six hospitals in the Eastern Region audit felt they had adequate numbers of consultants while only one in four felt they had sufficient numbers of other medical staff. To achieve recommended staffing levels, consultant numbers would have to be increased by over 70 per cent.

Only five hospitals had observation wards for minor head injuries, and half the hospitals had no space to include one. All the hospitals had computed tomography scanning facilities, but over a third complained of access problems because of lack of resources or radiologists. Only Addenbrooke's Hospital offered specialist neurosurgical care to patients requiring treatment for more than 48 hours. Only two hospitals had designated beds for patients with moderately bad head injuries, and there was little interest or expertise in treating them, the regional audit showed.

Immediate and long term rehabilitation was poor, and there was no formal system of follow up for patients with apparently minor head injuries.

The nationwide A&E survey showed that over half of head injury care was provided by general or orthopaedic surgeons, and not neurosurgeons. There were many complaints that surgeons were not interested in the treatment of head injury. Access to specialist beds was frequently difficult for almost a third of respondents. Yet one in six patients requires more than 48 hours in hospital, while one in 20 stay more than a week. And hospital follow up and rehabilitation services are poorly coordinated, the survey shows.

Only a third of A&E departments were involved to some degree in the care of head injuries, as recommended, while another third were willing to assume responsibility, but only providing resources were made available.

Both sets of authors conclude that levels of care for head injured patients are far from optimal.
[Implementing the Galasko Report on the management of head injuries: the Eastern Region approach 2001; 18: 358-65]
[Who cares for the patient with head injury now? 2001; 18: 352-7]

BMJ Specialty Journals

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