Quality standard

Quality statement 5: Access to neuroscience units

Quality statement 5: Access to neuroscience units

Quality statement

People with a head injury who have a Glasgow Coma Scale (GCS) score of 8 or less at any time have access to specialist treatment from a neuroscience unit.

Rationale

A GCS score of 8 or less indicates a severe traumatic brain injury. People with GCS scores of 8 or less will benefit from specialised clinical management provided by a neuroscience unit.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of locally agreed transfer protocols between the ambulance service, emergency department, district general hospital and designated neuroscience unit.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from transfer protocols.

Process

Proportion of emergency department attendances of people with a head injury and a GCS score of 8 or less at any time for which there is a documented record of ongoing liaison with or transfer to a neuroscience unit.

Numerator – the number in the denominator for which there is a documented record of ongoing liaison with or transfer to a neuroscience unit.

Denominator – the number of emergency department attendances of people with a head injury and GCS score of 8 or less at any time.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Mortality from skull fracture and intracranial injury.

Data source: Indicator P00103 in NHS Digital's Compendium of Population Health Indicators. Directly standardised rate, all ages, 3‑year average.

What the quality statement means for different audiences

Service providers (emergency departments, ambulance services, district general hospitals, major trauma centres, trauma units and specialist neurological centres) ensure that there are agreed protocols for ongoing liaison about the management of head injury in people with a GCS score of 8 or less, and when to transfer to a neuroscience unit.

Healthcare professionals ensure that people with a head injury and a GCS score of 8 or less have access to specialist treatment through ongoing liaison with or transfer to a neuroscience unit.

Commissioners ensure that appropriate pathways and protocols are in place for specialist treatment of head injury in people with a GCS score of 8 or less through ongoing liaison with and transfer to a neuroscience unit.

People with a head injury who show signs of severe brain injury are cared for with advice from specialists in brain injury, or have their care transferred to a clinic that specialises in treating brain injury.

Source guidance

Head injury: assessment and early management. NICE guideline NG232 (2023), recommendation 1.8.1

Definitions of terms used in this quality statement

Glasgow Coma Scale

In people with a head injury, the GCS is an early assessment of the severity of any associated traumatic brain injury. It is a standardised system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The scale has 3 domains: eye opening, verbal and motor responses. These are all evaluated independently in the scale according to a numerical value that indicates the level of consciousness and degree of dysfunction. The scores in each element of the GCS are summed to give the overall GCS score, which ranges from 3 (unresponsive in all domains) to 15 (no deficits in responsiveness):

  • mild traumatic brain injury is a GCS score of 13 to 15

  • moderate traumatic brain injury is a GCS score of 9 to 12

  • severe traumatic brain injury is a GCS score of 8 or less.

[NICE's guideline on head injury, terms used in this guideline]

Neuroscience unit

A neuroscience unit is a specialist centre or a unit that has facilities for neurosurgery and neurointensive care. [NICE's 2014 full guideline on head injury]