Evidence map›Paper›PMID 30580260›Full record

ArticleBMJ open2018

Impact of the SIGN head injury guidelines and NHS 4-hour emergency target on hospital admissions for head injury in Scotland: an interrupted times series.

Carl Marincowitz, Fiona E Lecky, Eleanor Morris, Victoria Allgar, Trevor A Sheldon

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients.International journal of environmental research and public health · 2025
    Observational
  4. Heads up for concussion, what do emergency physicians know? A scoping review.BMC sports science, medicine & rehabilitation · 2025
    Article
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Carl MarincowitzHull York Medical School, Allam Medical Building, University of Hull, Hull, UK.
Fiona E LeckyUniversity of Sheffield, School of Health and Related Research, Sheffield, UK.
Eleanor MorrisHull York Medical School, Allam Medical Building, University of Hull, Hull, UK.
Victoria AllgarHull York Medical School, John Hughlings, University of York, York, UK.
Trevor A SheldonDepartment of Health Sciences, Alcuin Research Resource Centre, University of York, York, UK.

Funding

Department of Health DRF-2016-09-086
6 · The paper itself

Abstract

objectivesHead injury is a common reason for emergency department (ED) attendance. Around 1% of patients have life-threatening injuries, while 80% of patients are discharged. National guidelines (Scottish Intercollegiate Guidelines Network (SIGN)) were introduced in Scotland with the aim of achieving early identification of those with acute intracranial lesions yet safely reducing hospital admissions.This study aims to assess the impact of these guidelines and any effect the national 4-hour ED performance target had on hospital admissions for head injury.

settingAll Scottish hospitals between April 1998 and March 2016.

participantsPatients admitted to hospital for head injury or traumatic brain injury (TBI) diagnosed by CT imaging identified using administrative Scottish Information Services Division data. There are 275 hospitals in Scotland. In 2015/2016, there were 571 221 emergency hospital admissions in Scotland.

interventionsThe SIGN head injury guidelines introduced in 2000 and 2009. The 4-hour ED target introduced in 2004. OUTCOMES: The monthly rate of hospital admissions for head injury and traumatic brain injury. STUDY

designAn interrupted time series analysis.

resultsThe first guideline was associated with a reduction in monthly admissions of 0.14 (95% CI 0.09 to 4.83) per 100 000 population. The 4-hour target was associated with a monthly increase in admissions of 0.13 (95% CI 0.06 to 0.20) per 100 000 population. The second guideline reduced monthly admissions by 0.09 (95% CI-0.13 to -0.05) per 100 000 population. These effects varied between age groups.The guidelines were associated with increased admissions for patients with injuries identified by CT imaging-guideline 1: 0.06 (95% CI 0.004 to 0.12); guideline 2: 0.05 (95% CI 0.04 to 0.06) per 100 000 population.

conclusionIncreased CT imaging of head injured patients recommended by SIGN guidelines reduced hospital admissions. The 4-hour ED target and the increased identification of TBI by CT imaging acted to undermine this effect.

Indexed as

Practice Guidelines as TopicTime-to-TreatmentAdultBrain Injuries, TraumaticCraniocerebral TraumaDatabases, FactualEmergency Service, HospitalFemaleHumansInterrupted Time Series AnalysisMaleMiddle AgedOutcome Assessment, Health CarePatient AdmissionPatient SafetyRetrospective Studieshead injuryinterrupted time seriesNhs 4-hour emergency department performance targetsign guidelinestraumatic brain injury

Identifiers

PMID30580260
PMCPMC6318526

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.