A Closed-Loop Clinical Audit on Compliance With National Institute for Health and Care Excellence (NICE) Guidelines (NG232) for CT Cervical Spine Imaging in Adult Head Injury Patients

Objective: CT cervical spine imaging is essential for early detection of cervical spine injuries in adult head trauma patients. Standard clinical guidelines provide specific criteria for when CT cervical spine imaging should be performed in such patients. This audit aimed to assess and improve compliance with these guidelines in a tertiary care neurosurgical unit in Pakistan. Methods: A closed-loop clinical audit was conducted at Imran Idrees Teaching Hospital, Sialkot. The initial audit retrospectively assessed adult head injury patients against the recommended guidelines criteria. A targeted intervention was implemented, including staff education, dissemination of guideline posters, and reinforcement of documentation practices. A prospective re-audit was then performed, and compliance before and after the intervention was compared. Results: In the initial audit cycle, 34 out of 37 patients met the guideline criteria, of whom 10 (29.4%) underwent CT cervical spine imaging. Following the intervention, 30 out of 33 patients met the criteria in the re-audit, and 25 (83.3%) of them received appropriate imaging. The intervention effectively improved guideline adherence and closed the audit loop. Conclusion: This closed-loop audit demonstrated that targeted interventions can significantly improve compliance with standard clinical guidelines for cervical spine imaging in head injury patients. Regular audit cycles, staff education, and guideline reinforcement play a key role in enhancing imaging practices and patient safety, especially in low-resource healthcare settings.