Impact of traumatic brain injury and associated hospital resource utilization on an Orthopaedic Department service

Abstract

Orthopaedic units are responsible for the care of head injuries in 35% of NHS hospitals in England. The resources available, in terms of manpower, facilities, and beds vary in different hospitals. In a prospective study of traumatic head injuries in our hospital we have analyzed the demographic, socioeconomic factors, referral patterns, morbidity and mortality. Also we have studied the appropriateness of the Orthopaedic unit taking this responsibility on the backdrop of the guidelines developed by the Royal College of Surgeons, England. All patients admitted in our Orthopaedic unit with head injury over a period of 5 years from 2002 to 2006 were included. Information on age, sex, mechanism of injury, GCS, co-morbidities, associated skeletal injuries, alcohol, CT scans, discharge pattern and mortality were recorded. We had 87 patients who were admitted with head injury. The mean age was 44.8 years with 25% above 65 and the eldest being 95 years. Only 36% of patients were discharged within 48 h, the maximum length of stay being 99 days with an average of 10.8 days. 20 patients were admitted to the ITU and 2 patients needed HDU stay. Alcohol consumption contributed to the injury in one out of seven patients. Fifty patients had CT scan evidence of head injury and 7 patients succumbed to the effects of the injury. Eleven patients had associated orthopaedic injuries. Traumatic brain injuries with or without influence of alcohol are a substantial contributor to the health resource burden for the NHS in UK. Length of hospital stay will have an impact on delivery of major Orthopaedic and trauma service. Enrolment in comprehensive clinical pathways may decrease length of stay for non-intensive care hospitalization. Intervention efforts should be directed towards supportive services from A and E and critical care at an earlier stage to reduce the impact on orthopaedic services. Language: en