Early Rehabilitation in Head Injury; Can We Improve the Outcomes?

BACKGROUND The quality of care after head injury is still very variable with a little coordination between different specialties. Acute care dominates, often with little regard to rehabilitation needs. OBJECTIVES To improve the outcomes of all head injury admissions to hospital, including mild and moderate, by creating a head injury team to supervise a rehabilitation clinical pathway. PATIENTS AND METHODS A head injury team was established to manage the care of all non-neurosurgical admissions with head injury to a large teaching hospital. Apart from inpatient care, the team coordinates various services involved in the care of head injuries, arranged suitable follow-ups, supported relatives and trained healthcare staff on general wards in the treatment of head injured patients. Follow-up clinics at 6 weeks and 6 months were arranged. RESULTS In the first three years, the team managed the care of 812 admissions. Mean age was 44.3 years (SD = 24.8) and mean length of hospital stay was 6.1 days (SD = 10.9). Of these individuals, 674 attended for 6 month follow-up with 52.2% having a good outcome on Extended Glasgow outcome score. Patients and their relatives' feedbacks were excellent with an average score of 4.7/5 on overall satisfaction rating. Following presentations at national meetings and elsewhere, other centers in the United Kingdom are now setting up similar pathways. CONCLUSIONS A dedicated clinical pathway and head injury team can improve the quality of care for all admissions with head injury and enhance the role for rehabilitation medicine input at an early stage.