ROUTINE FOLLOW-UP AFTER HEAD-INJURY - A 2ND RANDOMIZED CONTROLLED TRIAL

Objective-To confirm that patients admitted to hospital with a head in jury benefit from a routinely offered early intervention service. Pati ents and methods-A mixed rural and urban Health District of 560 000 pe ople with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are mini mal. All patients aged 16-65 years admitted to hospital after a head i njury of any severity, with or without other injuries entered the tria l. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group offered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months aft er injury. The primary outcome measure was the Rivermead head injury f ollow up questionnaire, a validated and reliable measure of social dis ability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and offered assessm ent and interventions as needed. These initially focused on the provis ion of information, support, and advice. Forty six per cent of patient s in the trial group also received further outpatient intervention or additional support by telephone. Results-314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 con trol patients were followed up at six months after injury. Patients' p osttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial gro up patients had significantly less social disability (p=0.01) and sign ificantly less severe post-concussion symptoms (p=0.02) at follow up a t six months after injury than the control group patients. Conclusions -The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the Light of these results and those from a previous randomised controlled trial.