Stepping out after brain injury

MANAGEMENT IN THE EMERGENCY DEPARTMENT: PREPARING PEOPLE FOR THE BEST

D. Yates.

University of Manchester

Emergency departments have changed radically over the past 20 years, both in their mission and in the training and competence of their staff. They are now in a strong position to influence the initial experience of head injured patients and the longer term care of those who do not require neurosurgical intervention. This may not be very evident to those waiting for treatment or, sometimes, to other disciplines in the acute sector that have historically been responsible for inpatient care. A reflection perhaps of the variable integration of services between hospitals and their local communities and the inconsistent application of current knowledge. This is changing.

The management of the patient who has an evident and serious brain injury has been improved by the adoption of a “team approach” to priority assessment and investigation. This has been extended to include regional co-ordination in many centres but problems with critical care bed provision continue to hamper progress. There is good evidence that survival increased after a number of initiatives were introduced in prehospital and emergency department care in the late 1980s but that this progress has now plateaued.

The outcome after less serious injury has been less well documented. Indeed, until 20 years ago most emergency clinicians did not consider the so-called minor head injury to pose a significant medical challenge. Emergency departments do now recognise the problem, but often are unable to do much about it because the necessary support services are either absent or unknown to them. With so many patients presenting with apparently mild head injury and the knowledge that many get better almost despite treatment, it is clearly important to try to identify those who will benefit most from specialist follow up. Tests are required that can be applied quickly and simply in …