Interventions and service need following mild and moderate head injury: the Oxford Head Injury Service.
OBJECTIVE: To describe the interventions given by the Oxford Head Injury Service (OXHIS) to patients seen after head injury, predominantly mild or moderate, over the first six months after their injuries. DESIGN: Descriptive data of the amounts of early intervention provided by OXHIS in relation to severity of head injury and the amount of service need identified at six month follow-up. SETTING: OXHIS aimed to register all patients aged 16-65 with a head injury of any severity, resident in Oxfordshire. It contacted and provided interventions for a random half of those registered at 7-10 days post-injury as part of a randomized controlled trial to investigate the effectiveness of early follow-up. At six months post-injury, independent assessment of all those registered was undertaken to evaluate outcome and identify continuing service needs. SUBJECTS: The data come from the 579 patients (of the 1156 registered), randomized to receive the new service at 7-10 days post-injury. All but eight of these received some form of service, and 252 of the randomized patients were available for interview at six months post-injury to assess their continuing service need. RESULTS: In the first five months after head injury: 240 patients received postal information alone and were not otherwise in contact with the service; 127 had telephone contact, advice and information; 93 were seen in person, assessed and given advice and information; 78 needed more help and support from the OXHIS team over the telephone; and 33 required further face-to-face contact either from OXHIS or other services. Extensive use was made of standardized leaflets but only accompanied by individualized assessment and advice. At six months 252 of the 579 patients were interviewed: 101 had no problems; 136 needed further reassurance; and 15 required further intervention. Patients with longer periods of post-traumatic amnesia (PTA) were more likely to receive a higher level of service, but the majority of patients who received the more extensive services were those with 'mild' and 'moderate' head injuries. CONCLUSIONS: Although the amount of service provided at 7-10 days post-injury increased with severity of head injury, most service was in fact given to patients with milder head injuries which were much more common. The majority of patients seen at six months post-injury needed reassurance, advice or other services, and monitoring of patients for some time after their head injuries does seem warranted. A population of 560,000 people could receive service from three whole-time equivalent (WTE) staff using these assessment and management protocols.