NCEPOD: Trauma - Who Cares? - London Health Programmes

8Head injury management“CT imaging of the head should be performed (i.e. imagingcarried out and results analysed) within one hour of therequest having been received by the radiology department.”The practice demonstrated in this dataset fell well short of thatguidance. As a result there is the potential for delays in bothdiagnosis and subsequent management of reversible pathology.timely fashion. Patients with severe head injuries, whosemanagement is most time critical, did not appear to havemore timely investigations. Again it should be noted thatthe main reasons for delay were organisational, rather thanpatient related, factors.Interpretation of CT scansAdvisor assessment of investigationof head injuryThe advisors assessed whether a head CT scan was anecessary part of each patient’s management. Table 82shows these data and makes the point that there wasgeneral agreement between the clinical decisions and theadvisors’ opinions. However, in 23/539 cases it was thoughtthat a CT scan was performed unnecessarily. Also in 24/220cases a CT scan was indicated although this was notperformed: and it was felt that the lack of CT scanning mayhave missed potentially treatable pathology.Accurate interpretation of the CT scan is essential. Tables83 and 84 show the grade and specialty of cliniciansinvolved. The majority of images were reported byconsultant radiologists. These data were taken from the A&Equestionnaire and most likely refl ect the fi nal report of theCT scan. Most investigations performed, particularly out ofhours, had a provisional report written in the notes by a morejunior doctor.Table 83. Grade of clinician interpreting the CT scanNumber of patients %Consultant 196 59.9Table 82. Advisors’ opinion on the necessity ofa head CT scanCTscanCT necessaryYes No Subtotal InsufficientdataTotalYes 516 23 539 10 549No 24 196 220 26 246Total 540 219 759 36 795NCCG 1