Development of a provincial guideline for the acute assessment and management of adult and pediatric patients with head injuries

Background: Regionalized approaches to trauma care improve patient outcomes. We developed and distributed a clinical reference poster to standardize the emergency department evaluation and management of patients with traumatic head injuries in hospitals throughout Nova Scotia. Methods: We conducted a MEDLINE literature search to identify publications in the fields of prehospital and emergency management of head injuries. We reviewed and collated select studies to define contemporary standards of care. Results: We derived a 3-tiered decision tool that summarizes the indications for resuscitation, radiography, specialty consultation and transfer of adult and pediatric patients with minor and major head injuries. A guideline poster was constructed and distributed to all provincial emergency departments upon approval by local trauma and critical care staff. Conclusions: This report describes the evidence for a population-based, province-wide assessment and early management tool that was developed for health care personnel who treat patients with head traumas. Comparison of outcome data from preand postguideline eras will ultimately shed light on the use of regionalized approaches to managing brain injuries.