[Treatment of patients with acute head injury in Vestfold 1987-96].
BACKGROUND
In Norway, patients with severe head injuries are transported to a regional, neurosurgical department for surgery, but some are operated on by surgeons without neurosurgical training in local hospitals.


METHODS
Data were retrospectively collected from the records of all patients (n = 161) hospitalised alive with a severe head injury occurring within Vestfold County (1987-96).


RESULTS
Overall lethality was 27%. 54 patients (34%) underwent decompressive surgery. 31 patients were operated in the local hospital, by 13 different surgeons. 30 of these patients had extracerebral haematomas. These patients had a significantly worse outcome than the 23 patients operated in a regional neurosurgical department. Patients with an epidural haematoma had a better outcome than patients with an acute subdural haematoma. We retrospectively classified ten operations in the local hospital as inadequate.


CONCLUSIONS
In Norway and countries with a similar hospital system, local hospitals should establish guidelines for safe and swift transport of head injury patients to the nearest neurosurgical department, and should not try to perform neurosurgical decompression in such patients.
Wester
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T
Ortopedisk avdeling Vestfold sentralsykehus, Tønsberg.
Fevang
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LT
Wester
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K
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods / Q000401:mortality / Q000592:standards; D004630:Emergencies; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006766:Hospitals, County; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000401:mortality / Q000592:standards*; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome