Researchers are developing digital health technology which could enhance future patient access to up-to-date specialist advice to better support recovery.
A comprehensive national audit led by researchers from the University of Birmingham and Queen Elizabeth Hospital Birmingham has revealed that the quality of head injury discharge advice provided by NHS England Trusts is not meeting current standards.
The study, which assessed 99 leaflets from across the country, found that none of the materials fully complied with the National Institute for Health and Care Excellence (NICE) 2023 guidelines. With increasing recognition of the impact of concussion, this study highlights that significant improvements should be made to better support recovery of symptoms and return to normal life after concussion.
Head injuries are among the most common reasons for emergency department visits in England and Wales, with over one million cases annually. The vast majority (up to 90%) are diagnosed as mild traumatic brain injury (mTBI), commonly referred to as concussion.
Though concussion does not usually require hospital treatment, over a third of concussion patients report persistent symptoms six months post-injury, including headaches, dizziness, severe fatigue and mental health problems. These significant symptoms can lead to those affected being unable to work, study or exercise.
Key findings of the study include:
Updating the advice patients receive upon discharge with concussion has scope to reduce the burden of long-term symptoms and delays in return to work after injury after concussion, which would help to reduce costs and improve patient outcomes.
Andrew Stevens, NIHR Academic Clinical Lecturer in Neurosurgery and co-lead of the study, said:
“The study identified that many leaflets provide outdated or even no information for patients on supporting their recovery return to normal life, highlighting a missed opportunity to fully support patients with up-to-date advice.
“Safety-netting advice was mostly well covered across the range of materials we reviewed; these are the signs of possible life-threatening problems and when to return to hospital. However, the study shows that there is generally a lack of guidance on rehabilitation and self-management. There are lots of simple measures which have been shown to help avoid prolonged symptoms, but many patients aren’t being told about them.
“Updating the advice patients receive upon discharge with concussion has scope to reduce the burden of long-term symptoms and delays in return to work after injury after concussion, which would help to reduce costs and improve patient outcomes.”
The main treatment for concussion is a short period (24-48 hours) of relative rest, especially minimising use of screens. This is followed by careful and gradual reintroduction of normal activities. For many, specific exercises can also help with typical symptoms such as dizziness or neck pain.
However, people with concussion are currently not monitored to ensure that they are recovering well, and do not receive standardised information on ways to improve their recovery.
The study proposes the following recommendations for updated care and discharge materials.
Key recommendations:
Antonio Belli, Professor of Trauma Neurosurgery and co-lead of the study, commented:
“Early and accurate intervention after injury is key to improving recovery, yet provision of specialist care such as this uncommon outside of elite sports settings. Broadening access to such assessment and interventions across the NHS therefore offers a significant opportunity for improving outcomes."
In light of these findings, the team have received funding from the NIHR to develop a digital health technology, aiming to improve access to guidance on self-management after concussion.
The team have carried out extensive work with other expert clinicians and a patient group to develop the app, known as Cedar (Concussion Education and Rehabilitation), which is currently in the final stages of development and is funded by the Health and Care Research (NIHR) National Institute, via the NIHR i4i FAST scheme.
Once completed, a short study will invite ten people with concussion to use the app. After use, these patients will be interviewed to provide detailed feedback on their experiences. The team will then be seeking funding to further develop and test Cedar, with the eventual aim that this can become an accessible tool for patients.
Andrew Stevens added:
“There are evidence-based tools that people could use to help monitor and manage their own symptoms and recovery after concussion, but these are not widely available outside of specialist settings. Cedar is about making these usable, engaging and accessible to everyone.”
For more information about the Cedar app, check out its website.
For media enquiries please contact Holly Young, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.
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NIHR Academic Clinical Lecturer in Neurosurgery
Staff profile for Mr Andrew Stevens, NIHR Academic Clinical Lecturer in Neurosurgery based in the Department of Inflammation and Ageing, University of Birmingham.
Professor of Trauma Neurosurgery
Staff profile for Professor Tony Belli, Professor of Trauma Neurosurgery, Department of Inflammation and Ageing, College of Medicine and Health, the University of Birmingham.
