Headway, the brain injury association, has welcomed updated guidance from the National Institute for Health and Clinical Excellence (NICE) on the triage, assessment, investigation and early management of head injury in children, young people and adults.

Peter McCabe, Headway Chief Executive, said: "We welcome these updated guidelines, particularly as they reinforce the need for high-quality written discharge information to be given to patients upon leaving hospital following a brain injury. In 2010, Headway's own research revealed that the vast majority of hospitals across the UK were failing to provide adequate information on the danger signs to look out for that require an immediate return to hospital. The challenge now is ensuring hospitals actually act on this updated guidance.

"It is also pleasing to see the recommendation that hospital discharge information includes contact details for local organisations - such as Headway groups and branches - that may be of support to patients on leaving hospital. Again though, this is only useful if all patients are given the information.

"Over a ten year period from 2002/3 to 2011/12, hospital admissions for head injury rose by a staggering 33.5%. While the vast majority of patients will suffer no lasting effects, many others will be left with lifelong brain injuries. The unpredictability of head injuries demands the highest level of clinical excellence in the early stages of assessment and treatment and we hope these updated guidelines will ensure that is the case for all head injury patients."

The original NICE guidelines for head injury were produced in 2003 and updated in 2007 and the latest guidance was issued last month (January 2014).  For these purposes, head injury is defined as ‘any trauma to the head other than superficial injuries to the face’. The early guidance about the use of head CT scanning and referral to specialist centres has resulted a in a reduction in the number of fatalities arising from head injury. The driver for the most recent update is the recognition that evidence-based guidance is the best way to risk assess and manage head injury in the early stages. Since 2007, developments which affect this guidance have included the establishment of regional trauma centres and an increased focus on safeguarding, an issue which can be very relevant in child head injuries.

The guidelines’ focus is on early assessment to identify which patients have suffered brain injury or are at risk of brain injury and to ensure that they receive timely CT scanning and/or admission to a regional neuroscience centre. The latest statistics suggested that 1.4 million people attend A&E each year with head injury, with up to half of those being children. These figures demonstrate the need for early assessment of patients who are at risk  or need urgent intervention. 

Philippa Luscombe, head of the personal injury team at Penningtons Manches LLP, commented: “The NICE guidelines have made a real difference to the assessment and management of head injuries but were six years old. It is good to see updated guidance being published and a focus on early assessment but also on the provision of information to patients and their families. In the majority of cases, head injuries are minor with no lasting effects but, where an individual is at risk of brain injury,  early specialist intervention can make a huge difference to the outcome. Given the devastating effect of serious brain injury, anything that can be done to improve outcomes is to be welcomed.”