Direct transport versus interhospital transfer of patients with severe head injury in Norway

Abstract

This study compares injury severity and outcome of patients with severe head injury admitted directly to a neurosurgical department with those initially transferred to a local hospital. A retrospective analysis of all patients with severe head injury admitted to the Department of Neurosurgery at St Olav University Hospital, Norway, was carried out from 1998 throughout 2002. The study included 146 patients with a median age of 34 (1-88) years. Patients transported directly (57%) had lower field Glasgow Coma Scale (fGCS) [5.5 (3-15) vs. 7 (3-15), P=0.002], higher Injury Severity Score [31.8 (9-75) vs. 27.0 (9-75), P=0.023], higher mortality rates (31 vs. 15%, P=0.042) and reached the neurosurgical department earlier [1.8 (0.3-15.8) vs. 5.5h (0.8-23.0), P<0.001] than those undergoing transfer to a local hospital. Significantly more patients in the direct admission group with a fGCS <or=8 (83%) were intubated at the scene of accident than in the transfer group (38%) (P<0.001). Multiple regression analysis adjusting for age, GCS and pupillary abnormalities did not predict increased mortality for the transfer group [odds ratio 0.43 (0.16, 1.14), P=0.09]. Patients with a severe head injury admitted directly to the neurosurgical department are more severely injured, more frequently get advanced medical treatment in the field, and are undergoing surgery earlier than transferred patients.