Abstract
IntroductionIn 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients.MethodsCase note data were collected for all trauma patients admitted to all hospitals accepting emergencies in England, Wales, Northern Ireland and the Channel Islands over a three-month period. Severely injured patients with an injury severity score (ISS) of ≥16 were included in the study. The case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received.ResultsOf the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381).ConclusionsThis study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities.
Highlights
KEYWORDSHead injuries – Trauma – Peer reviewAccepted 31 October 2012CORRESPONDENCE TOHeather Freeth, Clinical Researcher, National Confidential Enquiry into Patient Outcome and Death, Abbey House, 74–76 St John Street, London EC1M 4DZ, UKTrauma is the leading cause of death in the first four decades of life in the UK and a leading cause of ill health.[1]At least half of trauma cases are related to head injury[2] and these can be either in isolation or as part of polytrauma
This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities
An average district hospital is unlikely to treat more than one severely injured patient per week and as sufficient trauma experience cannot be achieved at all hospitals, optimal outcomes may be compromised
Summary
Head injuries – Trauma – Peer review. At least half of trauma cases are related to head injury[2] and these can be either in isolation or as part of polytrauma. It follows that head injury as a result of trauma can be a major cause of long-term morbidity and a large socioeconomic burden. For trauma patients with head injuries, timely resuscitation, avoidance of secondary brain injury and definitive operative care (where necessary) are prerequisites to optimal outcomes. An average district hospital is unlikely to treat more than one severely injured patient per week and as sufficient trauma experience cannot be achieved at all hospitals, optimal outcomes may be compromised. It has been recommended that all patients with acute severe head injuries are managed in a specialist neurosurgical/
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
