Going Home After a Head Injury

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Going Home After a Head Injury

• Jacqueline McPherson
• Paediatric Neurology Nurse Specialist
• Ward 7Neuroscience DepartmentRHSC

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Head Injuries

• April 2011 March 2012
• Attended AE - 1419
• Admitted from AE 113
• Classified into mild GCS 13-15
• moderate GCS 9-12
• severe GCS 8 or less
• (SIGN)

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Mild-Moderate Head Injury

• Support, information, advice and reassurance for
  child family
• School/Nursery point of contact
• Ward review
• Out-patient (OP) clinic appointment paediatric
  neurosurgery and/or paediatric neurorehabilitation
  

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Moderate Severe Head Injury

• A period of neuro assessment and rehabilitation
• Integrated Care Pathway
• Link with Education point of contact
• Wean off ward day pass, overnight pass,
  weekend pass
• Regular ward reviews and OP appointments

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FAQ

• Mood Temperament
• Memory
• Fatigue especially returning to school
• Sports

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SIGN Guidelines

• Mild - Some evidence to show that some children
  will have moderate disability and this group
  would benefit from telephone/postal follow up
• Moderate/Severe follow up is of benefit in
  terms of reducing behavioural changes, reducing
  anxiety and reducing reporting of symptoms

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Case Studies
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Case Study 1

• 11 year old girl
• Fell from monkey bars
• No loss of consciousness (LOC)
• Travelling to local emergency department (ED)
  became sleepy and incoherent
• CT showed a fracture extending through R mastoid
  and into the temporal bone, a small extradural
  (3mm) and a small pneumocephalus
• Transferred to Royal Hospital for Sick Children,
  (RHSC) Edinburgh and admitted into ward 7

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Case Study 1 Cont

• Post traumatic amnesia (PTA 24hrs)
• Continued with significant headaches and a
  further vomit
• Repeat scan showed no change
• In-patient for 4 days
• Remained neurological stable
• Discharge home with 6 week Neurosurgical follow
  up.

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Case Study 1 Cont

• Paediatric Neurology Nurse Specialist (PNNS) in
  frequent contact with Mum for support and
  information
• PNNS in contact with school about phased return
  and any difficulties which may be present

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Case Study 2

• 3 year old boy
• Fell 2 stories onto concrete
• Sustained a severe head injury/traumatic brain
  injury
• Intubated in Emergency Department

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Case Study 2 cont

• CT scan showed right subdural collections,
  frontal lobe contusions and dramatic fracture
  from left parietal to right spheroid bone with
  injury to right orbital roof and adjacent muscles
  and proptosis (forward displacement of the eye)
• Transferred and admitted into intensive care unit
  (ITU)

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Case Study 2 cont

• On going problems with raised intracranial
  pressure
• Underwent bifrontal decompressive craniectomy
  (subsequent re-insertion of autologous frontal
  bone flap)
• Extubated and transferred to neuroscience unit
  (ward 7) for rehabilitation 2/52
• Multidisciplinary team discharge planning meeting
  5/52
• Discharged home 6 weeks after initial injury

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Case Study 2 cont

• Attending ward reviews and outpatient
  appointments
• Health Visitor for information and advice
• Nursery School for information, advice and
  reassurance
• Transition meetings nursery to primary
• Neuropsychology assessment
• Long term follow up

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Service Development

• Promote Role
• Enhance referral system e.g. surgical ward
  admissions
• Information packs