Triaging patients with serious head injury: results of a simulation evaluating strategies to bypass hospitals without neurosurgical facilities

Abstract

Objectives: to inform the debate on whether seriously head-injured adult patients should be transported directly to the regional neurosurgical unit or indirectly after evaluation and stabilisation at the nearest hospital. Design: a simulation model was constructed to compare triage strategies and to identify those that predicted the maximum survivors. In each strategy, an estimate of the patient's condition in the field was used to determine the receiving hospital. The model used data from previous publications and local ambulance service and hospital databases. In the absence of valid data, expert clinical estimates were made and subjected to sensitivity analyses. Setting: an area in the North West Midlands of UK, covered by six acute hospitals including one with a regional neurosurgical unit. Outcome measure: the number of survivors predicted by each triage strategy. Results: five strategies were identified which consistently predicted the highest number of survivors. Compared with current policy it was predicted that in the North West Midlands, ten lives per year could be saved (6 per million total population per year). The results from sensitivity analyses did not alter these successful policies. Conclusion: the successful strategies should be considered as potential improvements to be introduced into clinical practice.