Emergency imaging of head and cranio-facial injuries: Implementing NICE guidelines – a cross sectional analysis from western region of Nepal

Abstract

Background

Head injuries cause substantial mortality and morbidity and are largely preventable. Public awareness and prevention programs as well as safety measurements in risky working environment can be adopted to avoid trauma.

Methods

This prospective study was conducted in Radiology Department of a tertiary care center in Pokhara, Nepal over a period of 7 months (May 2014 to Nov 2014).  Patients were referred for CT scan procedure from Emergency Department with a history of head injury.  Data collection was done on the basis of preformed questionnaires which were set as per the NICE guidelines and were filled up by the physicians in the emergency department.  

Results

A total of 200 patients were included in the study. Road traffic accidents (86 cases, 43%) were the most common cause of head and cranio-facial injuries. Males, were more frequently subjected to injuries. 102 cases (51%) followed the NICE guidelines for CT procedure referral and 82 cases (41% of all cases) had positive findings on CT scan. 98 patients (49% of all cases) had no indications for CT scan according to NICE guidelines, however 16 cases among them (8% of all cases) showed positive findings on CT like moderate soft tissue injury and   nasal bone fracture.

Conclusion

The overall compliance with NICE guidelines was not achieved as expected; and overtriage with unnecessary CT scan was observed.  An educational program to the trauma team of hospitals may help the patients in terms of care and cost.