Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the impact of National Institute for Health and Care Excellence (NICE) head injury guidelines on deaths and hospital admissions caused by traumatic brain injury (TBI).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>All hospitals in England between 1998 and 2017.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Patients admitted to hospital or who died up to 30 days following hospital admission with International Classification of Diseases (ICD) coding indicating the reason for admission or death was TBI.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>An interrupted time series analysis was conducted with intervention points when each of the three guidelines was introduced. Analysis was stratified by guideline recommendation specific age groups (0–15, 16–64 and 65+).</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>The monthly population mortality and admission rates for TBI.</jats:p></jats:sec><jats:sec><jats:title>Study design</jats:title><jats:p>An interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The monthly TBI mortality and admission rates in the 65+ age group increased from 0.5 to 1.5 and 10 to 30 per 100 000 population, respectively. The increasing mortality rate was unaffected by the introduction of any of the guidelines.</jats:p><jats:p>The introduction of the second NICE head injury guideline was associated with a significant reduction in the monthly TBI mortality rate in the 16–64 age group (-0.005; 95% CI: −0.002 to −0.007).</jats:p><jats:p>In the 0–15 age group the TBI mortality rate fell from around 0.05 to 0.01 per 100 000 population and this trend was unaffected by any guideline.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The introduction of NICE head injury guidelines was associated with a reduced admitted TBI mortality rate after specialist care was recommended for severe TBI. The improvement was solely observed in patients aged 16–64 years.</jats:p><jats:p>The cause of the observed increased admission and mortality rates in those 65+ and potential treatments for TBI in this age group require further investigation.</jats:p></jats:sec>