The cost-effectiveness of investigation and hospital admission for minor head injury

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.

Research Team

Principal Investigator: Steve Goodacre
Project Manager: Abdullah Pandor
Operational Research: Matt Stevenson
Health Economics: Simon Dixon
Statistics: Alex Sutton
Emergency Medicine: Tim Coats, Fiona Lecky
Neurosurgery: Tim Pigott, Jake Timothy
Neuroradiology: David Hughes