According to the National Institute for Health and Care Excellence (NICE) 1.4 million people attend A & E in England and Wales each year following a head injury. Up to 700,000 will be children under the age of 15.
Early detection and prompt treatment is vital to save lives and minimise risk of disability, the updated guidance from NICE tells us. However a person may appear fine at first, particularly at the accident scene as it is not uncommon for symptoms of head injury to manifest themselves during the post accident phase for up to 72 hours.
We now know that the process by which injury to the axons in the brain takes place occurs due to a cascade of events that can take up to 72 hours to become fully apparent. This is one reason why ambulance and A & E personnel often fail to detect or record any symptoms of head injury. Another reason is because A & E casualty staff may not appreciate that a patient who responds appropriately to simple questions is actually in post traumatic amnesia.
On 22nd January 2014 NICE updated their guidance on head injury for hospital doctors, nurses and ambulance crews. Key changes in the guidance include:
|Cognitive Symptoms||Emotional and Behavioural Symptoms||Physical Symptoms|
|Short term memory||Disinhibited temper||Dizziness / sickness|
|Concentration||Impulsive spending patterns||Persistent headaches|
|Difficulty learning new information||Disinhibited behaviour||Persistent cumulative fatigue|
|Word finding / fluency||Lack of insight||Visual disturbance including light sensitivity|
|Difficulty multitasking||Anxiety and depression||Noise sensitivity|
|Difficulty problem solving||Impulsivity||Change in sense of smell or taste|
|Slower speed of thought||Change in sexual drive / function||Difficulty with fine coordination|
|Difficulty under pressure||Loss of motivation|
The above list is typical of the more subtle brain injuries. With the more severe injuries additional physical problems may present to include physical disability, significant speech problems and epilepsy.