Each year 1.4 million people attend emergency departments in England and Wales with a recent head injury. Between 33% and 50% of these are children aged under 15. Of this large number relatively few will go on to suffer serious acute complications leading to long term disability or death however the need to identify and treat those who are most at risk of such complications is paramount.
January 2014 has seen the publication of updated guidance from the National Institute for Health and Care Excellence (NICE) on the triage, assessment, investigation and early management of head Injury in children, young people and adults. The updated guidelines can be viewed here.
By way of further explanation ‘triage’ is the name given to the process of prioritising patient care based upon the severity of symptoms.
This NICE guideline offers best practice advice on the care of people with head injury. This is accordingly an important update.
The guidance does not, however, override the individual responsibility of medical professionals to make decisions appropriate to the circumstances of an individual patient.
The Guidance runs to some 63 pages but key areas include:
- Whether patients should be transported from the scene of injury directly to a neuroscience centre or the nearest emergency department
- The timing of CT head scans
- The relative cost effectiveness of different strategies for initial imaging of the cervical spine
- The information that should be provided to patients, family members and carers on discharge from hospital
It also reinforces the sad statistic that some 25% to 30% of children under 2 years old who are hospitalised with head injury have that injury as a consequence of abuse. NICE have published separate further Guidelines on child maltreatment.
There is also particular reference to the important transition for young people between the paediatric and adult services and the need to ensure that if the patient is under 16 their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. The Guide also makes reference to the need to follow the code of practice that accompanies the Mental Capacity Act 2005 and the code on deprivation of liberty safeguards.
For more information on legal issues arising from child, adolescent or adult brain injury please contact Martin Pettingell or a member of our serious injury team on 0800 316 8892.