Head injury: assessment and early management

Evidence

We found 98 studies in a search for observational studies, randomised controlled trials, and systematic reviews published between 31 May 2013 and 27 October 2016. We also included 1 relevant study from a total of 18 identified by members of the guideline committee who originally worked on this guideline. One additional study was identified in comments received during consultation on the surveillance decision

From all sources, we considered 100 studies to be relevant to the guideline.

We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.

See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline and other correspondence we have received since the publication of the guideline.

Views of stakeholders

Stakeholders were invited to comment on the decision not to update the guideline. Overall, 11 stakeholders responded. See appendix B for stakeholders' comments and our responses.

Ten stakeholders commented on the proposal to not update the guideline: 7 agreed with the decision and 3 disagreed with the decision.

One commentator suggested that the guideline should cover hypopituitarism as a consequence of head injury. However, because this disorder generally occurs some time after the head injury, it is outside of the remit of the guideline.

One commentator suggested that further recommendations on referral for rehabilitation should be made. However, in this surveillance review, we did not find any new evidence that could impact on recommendations around referral for rehabilitation, and no references were provided by the commentator to support an update in this area. Additionally, a guideline on rehabilitation for chronic neurological disorders, including traumatic brain injury, is planned.

One commentator highlighted a study on the cost effectiveness of CT in people on warfarin. This study was added to the summary of evidence from surveillance, but did not impact on current recommendations.

One commentator suggested that the guideline should include recommendations on sports-related concussion. The guideline did not consider sports-related concussion as a discrete type of injury. Sports-related concussion is thus covered by any recommendation in the guideline that applies to concussion (or mild traumatic brain injury). The strategy for selecting studies focused on methods for identifying people at risk of severe head injury. In response to the consultation comment, the search results were re-checked for studies relevant to concussion or mild traumatic brain injury. A further 2 studies were added to the summary of evidence from surveillance, but did not impact on current recommendations.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

NICE Surveillance programme project team

Kay Nolan
Associate Director

Philip Alderson
Consultant Clinical Adviser

Emma McFarlane
Technical Adviser

Lynne Kincaid
Technical Analyst

The NICE project team would like to thank the topic experts who participated in the surveillance process.

ISBN: 978-1-4731-2494-3