'My 15-month-old child fell over and bumped his head doctor. He's fine now but he's been sick 3 times since it happened'. 'Oh dear, that's not so NICE'.

摘要

Since the introduction of the CG56 from NICE (National Institute for Health and Clinical Excellence) in September 2007 there has been a dramatic paradigm shift in the emergency management of patients with traumatic head injury. Working in a paediatric emergency department in a large teaching hospital we are presently experiencing the full impact of this shift.The update presented a decision tool to decide which children (who presented with a GCS of 15) need to be imaged. The CG56 update is based primarily on the CHALICE study, a large multi-centre cohort study. By using the CHALICE rule a sensitivity of 98% was achieved for clinically significant head injury but this required a scan rate of 14%, which equated to 3188 CT scans from the 22,000 patients they recruited in the study.