RESUMEN
BACKGROUND: A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published. METHODS: A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance. RESULTS: The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing the patient's level of consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be sent home from the accident and emergency department increased (p < 0.001) from 1 (2%) to 13 (19%). CONCLUSION: The Scandinavian Guidelines for Management of Mild Head Injuries have had a significant impact on management practice in Norwegian hospitals.
Asunto(s)
Traumatismos Craneocerebrales/diagnóstico , Traumatismos Craneocerebrales/terapia , Tratamiento de Urgencia/normas , Adhesión a Directriz/normas , Difusión de la Información/métodos , Guías de Práctica Clínica como Asunto , Algoritmos , Traumatismos Craneocerebrales/clasificación , Traumatismos Craneocerebrales/complicaciones , Estudios Transversales , Árboles de Decisión , Servicio de Urgencia en Hospital , Tratamiento de Urgencia/estadística & datos numéricos , Medicina Basada en la Evidencia , Escala de Coma de Glasgow , Adhesión a Directriz/estadística & datos numéricos , Hospitales Públicos , Humanos , Programas Nacionales de Salud , Noruega , Selección de Paciente , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud , Factores de Riesgo , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X , Inconsciencia/etiologíaRESUMEN
A 44 year old woman with a severe drug induced tardive dyskinesia had previously been treated with a left thalamotomy and right deep brain stimulation. Thalamotomy abolished the right hemiballismus. Deep brain stimulation caused a moderate reduction of the remaining involuntary movements on the left side. After a minor orthopaedic operation under general anaesthesia, the dyskinesia disappeared completely, even with the deep brain stimulation turned off. The remission has now lasted for 41 months.