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 pre- and postguideline eras will ultimately shed light on the use of regionalized approaches to managing brain injuries.