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S. Bhakthavalsala, E. Rfidah, P. Ravi.Queen Elizabeth the Queen Mother Hospital, Margate, UK

Aims: To assess the impact of NICE guidelines on imaging of children admitted with head injury.

Methods: Case notes of all children admitted for head injury to the paediatric wards of the two acute hospitals under the East Kent Hospitals NHS Trust between 1 August 2004 and 28 February 2005 were reviewed. Subsequent admissions and A&E visits over the next six months were also noted to check its relevance to the head injury. Children initially admitted and managed elsewhere as well as children with suspected non accidental injury were excluded for the purpose of this study.

Results: 104 children with head injury were admitted to the paediatric wards during this period. 68 (65%) were male. Applying the NICE guidelines for imaging, 35 children qualified for an urgent CT scan. In reality, only 18 of these children had a CT scan of which seven were abnormal. Three children from the remaining 69 also had a scan all of which were normal. Among the eight children who had a skull x ray, two revealed a fracture, which were also picked up on the CT scan.

Conclusion: Existing practice in the trust resulted in 15.5% of admitted children having a CT scan. Strict application of the NICE guidelines would result in 25.9% of them being scanned. 38.8% of the children scanned (who also needed to be scanned according the NICE guidelines) had an abnormal result, whereas none of the children who received a scan from the group where it is deemed unnecessary by NICE had an abnormal scan. None of the 17 children who needed a scan based on NICE guidelines, but did not get one, had any head injury related hospital visits over the next six months. Therefore …

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