assessment and treatment of mild to moderate head injuries … · 2018-05-02 · head injury...
TRANSCRIPT
The Assessment and Treatment
of Mild to Moderate Head
Injuries within Orthopaedics
Megan Atkinson
Senior Physiotherapist
Southampton General Hospital
Nov 2015
Aims and Objectives
• Background of project
• Brief overview of mild-mod HI
• Why this is relevant to Orthopaedic therapy
• Service evaluation
• Core standards
• Therapy notes proforma
• Outcome
Background
• I started within UHS T+O therapy dept 2012
• Many pts on the unit for neuro monitoring and observation
• Varied treatment of pt group
• Time spent with HI nurse specialist
Head Injury Definitions
• NICE describes Head Injury as ‘any trauma to the head, other then superficial injuries to the face’ NICE 2003,2007,2014
• “Traumatic brain injury is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairments of cognitive, physical and psychosocial functions with an associated diminished or altered state of consciousness” By Segun T Dawodu
• Penetrating or closed injury
Classification of Head Injury Severity
Epidemiology
• Each year, 1.4 million people attend A&E in England & Wales with HI.
Of these, 200,000 are admitted and 1 in 5 will have serious HI.
• 95% of all head injury admissions have a GCS greater than 12 (mild head injury category).
The majority of fatalities are in the moderate – severe category.
Epidemiology (2)
• In the UK:
70 – 88% of head injuries are male
10-19% - 65yrs or older
40-50% - are children
0.2% - mortality of all head injury admissions
• Common causes:
Assaults – 30-50%
Falls – 22-43%
RTA- 25%
Alcohol is involved in up to 65% of head injuries
NICE 2014 (PAGE 22)
Evidence Base
• Very limited evidence
• Much more towards mod/severe HI
• NICE 2014 suggest pt info sheets. Did not mention therapy Ax
• Bayley et al 2012 discuss the importance of rehab for cognitive impairments
by implementing strategies
• More evidence for cognitive ax and treatment than for physical impairments
Service Evaluation
• Evidence base – minimal (more towards mod-severe HI)
• Discussion with seniors
• Benchmarking
• Core standards
Head Injury Core Standards
• Acute phase (0-48hrs)
• Receive contact from therapist
• Ax PCS (ie dizziness, nausea, mild head aches)
• Basic neuro ax (sensation/balance/transfers/mob) and ax of other injuries
• Stair ax
• Ref appropriate pts to OT
• Written info
Therapy Notes Proforma
Clinical Audit
• Retrospective audit – notes pre proforma and post proforma
• Audit against core standards (2016)
Thank You
References
• Bayley, M., Berrigan, L., Marshall, S., McCullagh, S. & Velikonja, D. (2012) ‘Clinical
practice guidelines for mild traumatic brain injury and persistent symptoms’,
Canadian Family Physician Vol. 58.
• Medscape.com., 2015. Traumatic Brain Injurt (TBI)- Definition and Pathophysiology:Segun
Toyin Dawodu [online][viewed 29 October 2015].
Available:http://emedicine.medscape.com/article/326510-overview
• NICE GUIDELINES [CG176] (2014) Head Injury: Triage, assessment,
investigation and early management of head injury in infants, children and adults.