SIGN: Early management of head injury (2009 update)

The guideline is an update of the 2000 guideline and covers the early management of head injury in adults and children.  It is based upon the best available evidence. It includes a paediatric quick reference guide and key priorities for audit.

Date of Publication: May 2009
Summary Posted: July 2009

Click here to see the full guideline

RCPCH comments:
The RCPCH welcomes the publication of this update but asks Members to note the following:

• The College recommends that Members refer to the NICE guideline on 'When to Suspect Child Maltreatment' for indicators for the possibility of non accidental injury.
• There are differences between this, and the NICE guideline on Head Injury (2007) in the following areas: criteria for referral to hospital and for admission, recommended versions of the Glasgow Coma Scale, criteria for referral for CT scanning, criteria for discharge, transfer where CT facilities are not available and follow-up advice. 

NICE Clinical Guideline - When to suspect child maltreatment

This guidance covers the clinical features (including physical and psychological symptoms) associated with maltreatment which may be observed by health professionals when a child presents to them.  It is aimed at all health professionals, including GPs, primary health and child health teams, professionals groups who are routinely involved in the care of children and families and those who may encounter children in the course of their professional duties.  It provides recommendations based upon the best available evidence.  Where there was a lack of evidence, informal and formal consensus methods were used. The guidance includes a quick reference guide and costing tools.

Date of Publication: July 2009
Summary posted: July 2009

Click here to see the full guideline

RCPCH Comments:
The RCPCH welcomes the publication of this valuable and important guidance and fully endorses it. The College notes that the NICE guideline uses less technical terms which in some areas may appear to differ from RCPCH documents. This is because the intended audience of the NICE guideline is front line health professionals rather than specialist paediatricians (although the guideline is also of relevance to paediatricians).

Click here to read the College's full statement.

SIGN: Management of invasive meningococcal disease in children and young people

This guideline covers best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age.  The guideline includes key audit criteria, a quick reference guideline and information for parents and carers.

Date of Publication: May 2008

Date Posted: April 2009

Click here to see the full guideline

Click here to see key messages of the SIGN Meningococcal Disease guideline presented by Dr Jack Beattie, Consultant Paediatrician, at the York 2009 Spring Meeting.

RCPCH Comments: The RCPCH feels that this is an extremely valuable guideline.  The recommendation that 'Parenteral antibiotics (either benzylpenicillin or cefotaximine) should be administered in children as soon as IMD is suspected and not delayed pending investigations' is a Grade D recommendation and based upon expert opinion.  Evidence from a systematic review by Hahne et al suggested that the use of parenteral antibiotics is inconsistent and that results are inconclusive.  SIGN have amended the guideline to include this reference, however the grading has not been altered as the recommendation is in line with advice from the Health Protection Agency.

NICE: Head injury (Update of NICE Head injury - June 2003)

This guideline is a partial update of the version produced in 2003 and covers best practice advice on the care of adults, children (aged 1-15years) and infants (under 1 year) who present with suspected or confirmed traumatic head injury with or without major trauma or who may be unaware that they have sustained a head injury because of intoxication or other causes.  The age groups 'infants and young children' (i.e., <5 years), as well as cut-off points of 10 and 12 years are used.  It is particularly relevant to healthcare staff in primary care and A&E as well as others who have direct contact with and make decisions regarding the care of patients who present with suspected or confirmed head injury.  It may also be relevant to those who may manage or treat people with a head injury such as the police and first aiders.
 
The guideline was developed in accordance with NICE's processes for guideline development and guideline update.  The Guideline Development Group included individuals from neurology, radiology, paediatric and adult accident and emergency medicine, rehabilitation, cardiothoracic medicine, paediatric surgery, nursing, neurosurgery, ambulatory care, general practice, intensive care, anaesthetics, research and neuroradiology.  There was one parent/carer representative on the GDG.  Systematic searches to answer the clinical questions were carried out on the following databases: MEDLINE (1951-2006), EMBASE (1974-2006), PsycInfo (1806-2006), Health Economic and Evaluations Database and NHS Economic Evaluation Database.  Further searches were made for published guidelines.  The searches included evidence included in the databases until 8th January 2007 when the final search was carried out.  In the original guideline, recommendations were formulated using the highest level of evidence.  This information is not provided for the update.

The guideline includes a quick references guide, implementation advice, costing tools, audit criteria, a sample referral letter, and slides highlighting the key messages.

Date of Publication: September 2007

Summary Posted: April 2008

Click here to see the full guideline  

Paediatric Accident and Emergency Research Group: Decreased conscious level

The scope of the guideline includes children aged 0-18 years who have a decreased conscious level and are being reviewed in a hospital setting.  Decreased conscious level is defined as a modified Glasgow coma score less than 14, or being unresponsive only to voice or being unresponsive on the AVPU scale.  The guideline does not apply to pre-term infants on a Neonatal Intensive Care Unit or full term infants with a decreased conscious level from birth onwards.  Also, the guideline does not apply to children with a previously diagnosed condition that is known to cause the decreased conscious level.

Date of publication: November 2005

Summary posted: October 2006

Appraisal Document Updated: January 20007

Click here to see the full guideline

Click here to see the RCPCH summary and appraisal document 

Paediatric Accident and Emergency Research Group: Children presenting to hospital with diarrhoea, with or without vomiting

The policy is for the child presenting to an acute facility (accident and emergency or admissions/ paediatric assessment unit) with acute diarrhoea (less than 7days) with or without vomiting. Children presenting with vomiting alone or chronic diarrhoea (greater than 7 days) are not considered. Further management decision over the next 6-12 hours and indications for review and discharge are also given.

Date of publication: November 2002

Summary posted: September 2003

Click here to see the full guideline

Click here to see the RCPCH summary and appraisal document

Notes: This guideline has been superseded by NICE Diarrhoea and Vomiting in Children Under 5 (2009) 

Paediatric Accident and Emergency Research Group: Post seizure management

The guideline provides recommendations for the management of children presenting following febrile seizures based on the best available evidence. It aims to promote consistency of care of patients with similar clinical problems and helps clinicians recognise those children at higher risk of meningitis and to take appropriate action and to determine the cause of the fever if febrile seizure is diagnosed.

Date of publication: July 2002

Summary posted: December 2002

Click here to see the full guideline

Click here to download the RCPCH summary and appraisal document

Notes: Due for review 

Paediatric Accident and Emergency Research Group: Children presenting with acute breathing difficulties

The guideline aims to provide clinicians with recommendations for the management of children presenting with acute breathing difficulty based on the available evidence. It also aims to promote consistency of care of patients with similar clinical problems and to guide the decision-making process of junior doctors seeing the majority of patients in the first instance.

Date of publication: January 2002

Summary posted: December 2002

Click here to see the full guideline

Click here to download the RCPCH summary and appraisal document

Notes: Due for review