Assessment of guidelines for Computed tomography in head injury and quality of care in Chiangrai Prachanukraw hospital

Abstract

           Traffic accidents are an important pubic health problem. As they are the leading cause of death or disability, especially among patients with severe head injury. Current use of Computed tomography (CT) as the gold standard diagnostic  imaging study for head injury is increasing rapidly. Objective : To study the basic characteristics of head injured patients and to assess  the sensitivity of CT scan based on the guidelines Design: Descriptive, retrospective study Setting: Chiangrai Prachanukraw hospital Subjects: 100 head injured patients in neurological service who underwent CT scan based on the guidelines during August 2003-February 2004 Methods: The patient care team(PCT) set up the guidelines for emergency CT scan by assessment of the initial Glasgow Coma Scale (GCS) and location of the skull fracture. The emergency CT scan was done for patients with severe head injury. Moderately and mildly injured patients were monitored for neurological signs and serial clinical assessments during admission in neurosurgery ward. For those who met criteria, the CT scan was done respectively. Medical records of all patients studied were reviewed and data collected included basic characteristics of the patient, cause of head injury, severity and abnormal CT scan findings. Data were analyzed, percentage and sensitivity were calculated. Results: 91% of severely head injured patients who underwent emergency CT scan based on the guidelines had positive CT scans. The criteria based on the guidelines used for CT scan among moderately and mildly head injured patients had 100% sensitivity. Conclusion: The guidelines for CT scan by assessment of Glasgow Coma Scale (GCS) in conjunction with serial clinical assessment is highly sensitive. Moreover, these guidelines could improve the emergency management, standardized the approach for head injured patients and lead to improved quality care. This will, in turn, decrease the overall cost and burden on the health care system.