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Republished paper: The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review
  1. Helen Barratt1,
  2. Mark Wilson2,
  3. Fionna Moore3,
  4. Rosalind Raine4
  1. 1Department of Epidemiology and Public Health, University College London, London, UK
  2. 2The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  3. 3London Ambulance Service NHS Trust/Consultant in Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
  4. 4Professor of Health Care Evaluation, Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Helen Barratt, Academic Clinical Fellow, Health Care Evaluation Group, Dept Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; h.barratt{at}


Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources.

The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. However, this raises issues about the capacity of regional neurosurgical units, particularly to accommodate patients who do not require surgical intervention.

Objectives To critically evaluate the basis of the NICE recommendations about transfer for neurosurgical care, and examine the configuration of specialist services to assess the implications of increasing the existing number of transfers.

Methods A systematic literature review was conducted of articles discussing the provision of emergency neurosurgical care for adult head injuries in the UK.

Results Fifty-eight papers met the criteria for inclusion in the literature review, including seven papers cited in the NICE guidance. Fifty-one papers related to neurosurgical care, including papers on bed occupancy, transfer times and transfer policies.

Conclusions The evidence NICE cited is of variable quality. Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched.

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  • This is a reprint of a paper published in Emergency Medicine Journal, March 2010, volume 27, pages 173–8.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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