CT Scanning for Minor Head Injury, NICE is failing
We read the two studies by the OCTOPUS investigators with great
interest. We recently surveyed all the Emergency Departments in England
and Wales as to implementing the NICE guidelines for Head injury, through
their lead Consultant. This guideline has advocated significantly
increased CT scanning rates for mild head injury. (1) Our response rate
was 75%. 69% of Emergency Department lead Consultants stated that they
were unable to implement the NICE guidelines for CT scanning head injury.
Implementation was more likely in larger departments, where Emergency
Department staff had responsibility for CT scan interpretation, where in-
patient care of head injured patients was the responsibility of the
emergency department, and when neurosurgeons worked in the same hospital.
The biggest perceived barriers to implementing increased CT scanning were
radiologist reluctance and a lack of radiologists. Against this background
of disregard for the NICE guidelines, implementing the results of the
OCTOPUS studies will be challenging, despite the estimated cost benefits.
It is surely time to start looking for imaginative solutions to this
problem? Surely emergency physicians should be responsible for the initial
interpretation of the CT scan and the radiologist provides the gold
standard report at leisure, the way that almost every other radiological
investigation is conducted? There is some evidence that this is safe. (3)
1. National Institute for Health and Clinical Excellence: Head injury
triage, assessment, investigation and early management of head injury in
infants, children and adults. Clinical guideline 4. London: NICE,
2003:96–7.
2. Sultan HY, Boyle A, Pereira M, Antoun N, Maimaris C: Application
of the Canadian CT head rules in managing minor head injuries in a UK
emergency department: implications for the implementation of the NICE
guidelines. Emerg Med J 2004, 21(4):420-5
3. Mucci B, Brett C, Huntley LS, et al. Cranial computed tomography
in trauma: the accuracy of interpretation by staff in the emergency
department. Emerg Med J 2005;22:538–40.
Rapid Response:
CT Scanning for Minor Head Injury, NICE is failing
We read the two studies by the OCTOPUS investigators with great
interest. We recently surveyed all the Emergency Departments in England
and Wales as to implementing the NICE guidelines for Head injury, through
their lead Consultant. This guideline has advocated significantly
increased CT scanning rates for mild head injury. (1) Our response rate
was 75%. 69% of Emergency Department lead Consultants stated that they
were unable to implement the NICE guidelines for CT scanning head injury.
Implementation was more likely in larger departments, where Emergency
Department staff had responsibility for CT scan interpretation, where in-
patient care of head injured patients was the responsibility of the
emergency department, and when neurosurgeons worked in the same hospital.
The biggest perceived barriers to implementing increased CT scanning were
radiologist reluctance and a lack of radiologists. Against this background
of disregard for the NICE guidelines, implementing the results of the
OCTOPUS studies will be challenging, despite the estimated cost benefits.
It is surely time to start looking for imaginative solutions to this
problem? Surely emergency physicians should be responsible for the initial
interpretation of the CT scan and the radiologist provides the gold
standard report at leisure, the way that almost every other radiological
investigation is conducted? There is some evidence that this is safe. (3)
1. National Institute for Health and Clinical Excellence: Head injury
triage, assessment, investigation and early management of head injury in
infants, children and adults. Clinical guideline 4. London: NICE,
2003:96–7.
2. Sultan HY, Boyle A, Pereira M, Antoun N, Maimaris C: Application
of the Canadian CT head rules in managing minor head injuries in a UK
emergency department: implications for the implementation of the NICE
guidelines. Emerg Med J 2004, 21(4):420-5
3. Mucci B, Brett C, Huntley LS, et al. Cranial computed tomography
in trauma: the accuracy of interpretation by staff in the emergency
department. Emerg Med J 2005;22:538–40.
Competing interests:
None declared
Competing interests: No competing interests