Adherence to the NICE traumatic brain injury management guidelines in a trauma centre during the covid pandemic

ABSTRACT

Objectives: The National Institute of Health and Care Excellence (NICE) has set standards for TBI patients' initial assessment and management. This study assessed respect for NICE TBI guidelines in patients referred to an English trauma centre during the Covid-19 pandemic. Design: A cross-sectional study. Subjects: TBI patients who presented to a District General Hospital between 1st December 2020 and 12th August 2021 and were referred to the tertiary neurosurgical centre. Methods: Data were collected from the electronic medical records of our subjects. Descriptive statistical analysis of the time between patients presenting to the emergency department, being reviewed by a trained member of staff, request for cranial CT imaging, and response to neurosurgical referral was done with SPSS version 27.0. Results: We collected data on 115 patients, and the TBI frequency peaked in the 60-99 age range. Most patients were men (55.9%, n = 65), and 77% had a frailty score of 5 or less, with 90% presenting with a GCS range of 13-15. At the referring hospital, twenty-eight percent (n = 32) of the patients were evaluated by a trained member of staff within 15 min of admission, and only 30% (n = 35) had cranial CT imaging within an hour of the assessment. Only half of the referrals (n = 58) were reviewed by Neurosurgeons within an hour. The most common lesion on cranial CT imaging was a subdural haemorrhage (34%, n = 40).