Details of HTA project
Last updated: 31 August 2010 - Next update due: 7 September 2010
Research type: |
Secondary Research (e.g. systematic review) |
Project title: |
The cost-effectiveness of investigation and hospital admission for minor (GCS 13-15) head injury |
 Outputs in journals arising from this project
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Project ref: |
07/37/08 |
Cost: |
£183,957 |
Chief Investigator : |
Professor Steven Goodacre, Professor and Consultant in Emergency Medicine, School of Health and Related Research, University of Sheffield |
Start Date: |
February 2009 |
Estimated date of publication in HTA journal series: |
April 2011. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Minor head injury (defined as a head injury from which the patient has recovered full consciousness) is responsible for over 600,000 patient attendances at emergency departments each year in England and Wales. A small but important minority of these patients will have bleeding around their brain, despite appearing to have made a full recovery. If this can be diagnosed early and operated on then their chances returning to normal health are excellent, but if diagnosis and treatment are delayed they may suffer serious disability or death. A variety of tests can be used to assess the risk of bleeding, each with a different degree of accuracy, convenience and cost to the NHS. It is not currently clear which testing strategy is most appropriate. A simple strategy would be cheap and convenient, but might fail to detect bleeding. An intensive strategy would reliably detect bleeding, but might be expensive and inconvenient and involve testing huge numbers of patients who have no bleeding. We plan to review all available scientific studies of tests for minor head injury and then develop a model to explore how each testing strategy would work in practice. This will allow us to weigh the benefits of early detection and treatment of bleeding against the costs and inconvenience of testing, and determine the most appropriate strategy for the NHS. Our study will ensure that patients with minor head injury will receive appropriate care, whilst ensuring that NHS resources are not wasted. The research will be carried out at the University of Sheffield. Our team includes leading experts in emergency care research and health care modelling, alongside practicing doctors in emergency medicine, brain surgery and radiology (x-rays and scanning). This combination of expertise will ensure that our recommendations are based on sound research and are relevant to routine NHS practice. We have extensive experience of undertaking similar analyses for the NHS and for the National Institute for Health and Clinical Excellence (NICE). There are no major ethical barriers to this research because it involves modelling patient care rather than directly interfering with patient care. Modelling allows us to explore a wide range of different ways of providing care for patients without ever putting patients at risk. |
Project Abstract: |
Head injury is responsible for around 700,000 emergency department attendances per year in England and Wales, most of which (90%) will be minor (CGS 13-15) and will not need immediate neurosurgical intervention or inpatient care. These patients have a small (<1%) but important risk of subsequent deterioration due to intracranial bleeding. If these cases are recognised and treated early then a full recovery can be expected, if not then severe disability or death may ensue. Despite recent guidelines from the National Institute for Health and Clinical Excellence (NICE) the annual costs of admission for head injury appear to have increased from around £70 million to £213 million. We aim to identify the optimal strategy for managing adults and children with minor (CGS 13-15) head injury. We plan to undertake a cost-effectiveness analysis based on secondary research (systematic review, meta-analysis and decision-analysis modelling) along with a national survey and analysis of routine data sources to determine the most appropriate diagnostic management strategy for adults and children with minor head injuries in the NHS. Our analysis will present: (1) Estimates of the diagnostic accuracy of clinical assessment, clinical decision rules, skull X-ray, cranial CT an inpatient observation for intracranial bleeding requiring neurosurgery; (2) Estimates of the cost-effectiveness of each potential diagnostic management strategy for minor head injury; (3) An optimal strategy for managing minor head injury in the NHS, suitable for incorporation into future NICE guidelines; and (4) Recommendations for future research that will produce optimal value for money for the NHS. |
Project Protocol: |
Project protocol (pdf format, 144 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1765 |
Outputs from this project
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