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

Carl Marincowitz; Fiona Lecky; Victoria Allgar; Trevor Sheldon

doi:10.1136/bmjopen-2019-028912

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

Carl Marincowitz^*, Fiona Lecky, Victoria Allgar, Trevor Sheldon

^*Corresponding author for this work

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

6 Downloads (Pure)

Abstract

ObjectiveTo 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).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients 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.InterventionAn 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+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe 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.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).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.ConclusionThe 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.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.

Original language	English
Pages (from-to)	e028912-e028912
Number of pages	0
Journal	BMJ Open
Volume	9
Issue number	6
Early online date	4 Jun 2019
DOIs	https://doi.org/10.1136/bmjopen-2019-028912
Publication status	Published - Jun 2019

Access to Document

10.1136/bmjopen-2019-028912

Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury an interrupte

Cite this

@article{61607120cf864611b9b1ba369cb43464,

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

abstract = "ObjectiveTo 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).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients 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.InterventionAn 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+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe 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.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).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.ConclusionThe 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.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.",

author = "Carl Marincowitz and Fiona Lecky and Victoria Allgar and Trevor Sheldon",

year = "2019",

month = jun,

doi = "10.1136/bmjopen-2019-028912",

language = "English",

volume = "9",

pages = "e028912--e028912",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

}

TY - JOUR

T1 - Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis

AU - Marincowitz, Carl

AU - Lecky, Fiona

AU - Allgar, Victoria

AU - Sheldon, Trevor

PY - 2019/6

Y1 - 2019/6

N2 - ObjectiveTo 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).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients 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.InterventionAn 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+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe 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.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).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.ConclusionThe 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.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.

AB - ObjectiveTo 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).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients 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.InterventionAn 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+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe 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.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).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.ConclusionThe 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.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.

U2 - 10.1136/bmjopen-2019-028912

DO - 10.1136/bmjopen-2019-028912

M3 - Article

SN - 2044-6055

VL - 9

SP - e028912-e028912

JO - BMJ Open

JF - BMJ Open

IS - 6

ER -

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

Abstract

Access to Document

Fingerprint

Cite this