Earlier, I discussed how guidelines can change over time which is to be expected. Guidance can also be implemented at short notice such as in these times of COVID. It is important to be aware of changes from NICE and as a practitioner, implement their latest guidelines. However, an expert needs to remain cogniscent of NICE guidelines that were applicable at the time of the alleged negligence.

Different Rules For Different Countries

If an expert accepts instructions on a basis other than just in their own country of work they have not only to be aware of any differences in the legal structures and legal treaties used in cases but also that there may be differing guidelines and that these may be updated on a different timescale.

Such a situation arises in the guidelines for head injuries (assessment and early management) where NICE has updated their original 2003 guidelines in 2007 and 2014 and then again in September 2019. 

In Scotland the Scottish Intercollegiate Guideline Network (SIGN) develops its own guidelines and their guidelines for head injuries were last revised in 2009.

Differences in the Requirement For A Formal Report

In the NICE guidelines CT scanning is not only to be done immediately in serious conditions but having done a CT scan, a provisional written report should be available within an hour of the scan. This was introduced in an updated version of the guidelines in 2014.

The SIGN guidelines do not have that time specific reporting requirement.

Differences in Coagulopathy

While the guidelines are very similar in the indications for CT scanning, the algorithms in the respective \quick reference guidelines place different emphasis on some of the key indications for urgent CT scanning. 

There is also a subtle difference between the use of the term coagulopathy in the SIGN quick reference guide. Here, an immediate CT scan is required compared to the NICE guidelines that only mention coagulopathy with reference to anti-coagulated treatment (and this has been expanded to include other anti-coagulants rather than just warfarin mentioned in the original guideline).

Being aware of the local guidelines and their implementation is important for an expert witness if they are to write a report that meets the standard of assessing clinical care against that of a responsible responsible clinician.