NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 8 - Head injury managementIn addition to a higher 72 hour mortality, head injured patientsrequired more critical care resources than non-head injuredpatients.Prehospital dataAssessment of neurological functionFigure 32 and Table 65 show the prehospital assessmentof conscious level in the patients who had suffered a headinjury. It should be noted that a patient report form (PRF) wasavailable for 320 of the 493 head injury group.Most patients had a Glasgow Coma Score (GCS) calculated,although some prehospital assessment was performed usingthe AVPU (Alert, Verbal, Pain, Unresponsive) scale. Eighteenpatients had no assessment of neurological dysfunction.Table 65. AVPU score in head injury groupNumber of patients %Alert 27 34.6Verbal 18 23.1Pain 13 16.7Unresponsive 20 25.6Subtotal 78GCS and/or AVPUnot recorded18Total 96It is important to document neurological status so that anychanges can be recognised and acted upon. Pupil sizeand reactivity should also be recorded when assessment ofconscious level is being made. NICE guidance recommendsthat the GCS should be used in all communications abouthead injured patients and that ambulance crews shouldbe fully trained in the adult and paediatric versions of theGlasgow Coma Scale 17 .Figure 32. Prehospital Glasgow Coma Score measurement in head injury group50Number of patients40302010015 14 13 12 11 10 09 08 07 06 05 04 03Glasgow Coma Score86