We would like to comment on the paper by Reed et al in which they describe the introduction of head injury guidelines which pre-date but essentially mirror those subsequently issued by NICE. In particular we are surprised at their conclusions. Their data show that following the introduction of these guidelines the number of CT scans performed doubled, but that this additional scanning did not reveal any additional intra-cranial abnormality. Furthermore their data also suggest that, contrary to NICE guidance, vomiting is not a useful indicator for CT scanning. It is also apparent that this guidance did not reduce admissions, and yet admission avoidance is often cited as a reason for adopting the NICE guidelines.
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