Quality of referrals and adherence to guidelines for adult patients with minimal to moderate head injuries in a selection of Norwegian hospitals.

Abstract

Purpose: This study aimed to assess adherence to the Scandinavian guidelines, the justification of referrals, and the quality of referrals of patients with mild, minimal, and moderate head injuries in a selection of Norwegian hospitals.

Methods: We collected 283 head CT referrals for head trauma patients at one hospital trust in Norway in 2022. The data included the patients' sex, age, and the referral text. Six radiologists independently assessed all referrals using a registration form developed based on the Scandinavian guidelines for patients with mild, minimal, and moderate head injuries and general referral guidelines. Descriptive statistics was used to analyze data on adherence to guidelines, while Gwet's AC1/2 was used to test the agreement between the raters.

Results: This study found that 65% of referrals were assessed to be justified according to the guideline by at least one rater, while 17% were rated justified outside the guideline. In 52%, at least one rater required more information. There was good to moderate interrater agreement.

Conclusions: Adherence to the Scandinavian guidelines and the quality of referrals of patients with mild, minimal, and moderate head injuries are low. Training and using S100B is recommended to improve the justification rate and quality of patient care.