NCEPOD: Trauma - Who Cares? - London Health Programmes

8Head injury managementHospital dataPre-alertsPre-alerts allow the emergency department to provide arapid and appropriate response. In the head injured patient,where there is very strong linkage between avoidanceof secondary injury and good outcome, this rapid andappropriate response is particularly important. Figure 34shows the use of pre-alerts analysed by prehospital GCS.The use of pre-alerts was variable. Even in the patient groupwith a GCS of 8 or less (severe head injury) there were asubstantial number of patients arriving at hospital withouta pre-alert. Indeed, in the group with a GCS of 3, 22.4%(17/76) of patients arrived at hospital without a pre-alert.NICE guidance on this aspect of care states 17 :“Standby calls to the destination A&E Department should bemade for all patients with a GCS less than or equal to 8, toensure appropriately experienced professionals are availablefor their treatment and to prepare for imaging”.Data from this study showed that practice was falling wellshort of this guideline. Fifty nine out of 160 (36.9%) patients,in which it was recorded, with severe head injury did nothave a pre-alert. Delays to the amelioration of secondaryinsults, imaging and defi nitive surgery (if required) couldadversely affect outcome.Figure 34. Prehospital Glasgow Coma Score and documentation of an ambulance pre-alert120Number of patients10080604020015 13-14 9-12 4-8 3 NotrecordedGlasgow Coma ScoreYesNo91