Admission policy for patients following head injury

Abstract

Summary In the 2 years following a change in the policy of admission following head injury in Nottingham, the number of patients admitted fell from 941 in 1977 to 536 and 460 in 1978 and 1979 respectively. No detrimental effects resulting from this change in policy have been noted. Previously, all patients who had been unconscious (however briefly) had been admitted. The changed policy stated that: 1. Patients who had been briefly unconscious or amnesic would only be admitted if one of the following factors was also present: abnormal neurological signs or obtunded consciousness on arrival at hospital, fits, vomiting, severe headaches or clinical or radiological evidence of a fracture of the skull. 2. Such patients would only be allowed home if instructions issued to the patients on a ‘head injury instruction card’ could be implemented satisfactorily. It is suggested that the implementation of such an admission policy will avoid the unnecessary admission of large numbers of patients, thus freeing beds for other purposes. The article leaves unanswered the question ‘Which patients should have a skull X-ray?’.