Care of head injuries falls well short of recommendations

Care of patients with head injuries falls well short of recommendations published two years ago, show two studies in Emergency Medicine Journal.

Audits of the whole of the Eastern Region of England and over 200 accident and emergency (A&E) departments in Great Britain and Northern Ireland, pinpoint major deficiencies in funding, staff, and service provision. The findings also show that levels of care vary considerably, and that rehabilitation and follow up of head injured patients are poor.

The Royal College of Surgeons issued a major report in June 1999 on the care of patients with head injury. This was followed by a further report from the Society of British Neurological Surgeons in February of last year.

The Eastern Region audit covered 20 acute hospital trusts plus the regional neurosurgical units at Addenbrooke's Hospital, serving nine of the 10 district hospitals, and Oldchurch Hospital, serving six district general hospitals. The nationwide audit of A&E departments obtained responses from 206 out of a possible 256.

Only six hospitals in the Eastern Region audit felt they had adequate numbers of consultants while only one in four felt they had sufficient numbers of other medical staff. To achieve recommended staffing levels, consultant numbers would have to be increased by over 70 per cent.

Only five hospitals had observation wards for minor head injuries, and half the hospitals had no space to include one. All the hospitals had computed tomography scanning facilities, but over a third complained of access problems because of lack of resources or radiologists. Only Addenbrooke's Hospital offered specialist neurosurgical care to patients requiring treatment for more than 48 hours. Only two hospitals had designated beds for patients with moderately bad head injuries, and there was little interest or expertise in treating them, the regional audit showed.

Immediate and long term rehabilitation was poor, and there wa

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