Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 20, 62

Evaluation of the Scandinavian Guidelines for Head Injuries Based on a Consecutive Series With Computed Tomography From a Norwegian University Hospital


Evaluation of the Scandinavian Guidelines for Head Injuries Based on a Consecutive Series With Computed Tomography From a Norwegian University Hospital

Ingrid Haavde Strand et al. Scand J Trauma Resusc Emerg Med.


Background: This study prospectively assesses clinical characteristics and management of consecutive minimal, mild and moderate head injury patients referred for CT scans. Compliance with the Scandinavian head injury guidelines and possible reasons for non-compliance is explored.

Methods: From January 16th 2006 to January 15th 2007, 1325 computed tomography (CT) examinations due to minimal, mild or moderate head injury according to the Head Injury Severity Scale (HISS) were carried out at our University Hospital. When ordering a CT scan due to head trauma, physicians were asked to fill out a questionnaire.

Results: Guideline compliance was impossible to assess in 49.5% of all cases. This was due to non-assessable or missing key variables necessary in the decision making algorithm. One or more key variables for HISS classification were not assessable in 34.4% as it was unknown whether there had been loss of consciousness (LOC), duration of LOC was unknown or it was impossible to assess amnesia or focal neurologic deficits. Definite compliance with both CT and admittance recommendations in guidelines was seen in only 31.2%. In 54.2% of patients with minimal head injuries who underwent CT scans, imaging was not necessary according to guidelines. 59.1% of all patients were admitted to hospital, however only 23.7% of these were admitted because of the head-injury alone. Age < 4 years, possible medical cause of injuries, severe headache/nausea or vomiting and the presence of non-traumatic CT findings were independently associated with non-assessable compliance with Scandinavian guidelines. Suspicion of influence of alcohol was inversely associated to non-compliance.

Conclusions: Despite the prospective study design, guideline compliance was not assessable in nearly half of the patients. Patients with isolated head injuries and available and obtainable complete clinical information necessary for guideline-based decision making are not dominating in a head injury population.


Figure 1
Figure 1
Decision-making algorithm by the Scandinavian Neurotrauma Committee. The figure shows the Scandinavian decision-making algorithm for the management of minimal, mild and moderate head injuries.
Figure 2
Figure 2
The inclusion and exclusion process. The inclusion and exclusion process leading to a study population of 1325 primary CT examinations after recent minimal, mild, or moderate head trauma is shown.

Similar articles

See all similar articles

Cited by 3 articles


    1. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391–1396. doi: 10.1016/S0140-6736(00)04561-X. - DOI - PubMed
    1. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343:100–105. doi: 10.1056/NEJM200007133430204. - DOI - PubMed
    1. Servadei F, Teasdale G, Merry G. Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. J Neurotrauma. 2001;18:657–664. doi: 10.1089/089771501750357609. - DOI - PubMed
    1. Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan Ch A, Traubner P, Twijnstra A, Vecsei L, von Wild K. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol. 2002;9:207–219. doi: 10.1046/j.1468-1331.2002.00407.x. - DOI - PubMed
    1. Ingebrigtsen T, Romner B, Kock-Jensen C. Scandinavian guidelines for initial management of minimal, mild, and moderate head injuries. The Scandinavian Neurotrauma Committee. J Trauma. 2000;48:760–766. doi: 10.1097/00005373-200004000-00029. - DOI - PubMed

MeSH terms