Management of head injury in a regional hospital.
BACKGROUND
Concern about delay in the treatment of serious head injury may result in unnecessary transfer to neurosurgical units for scanning and neurosurgical assessment.


OBJECTIVE
This study assessed the management of head injuries in a regional hospital with computed tomographic (CT) and 'image-link' facilities allowing instantaneous transmission of CT scans to the regional neurosurgical unit for specialist assessment.


METHODS
A retrospective study was carried out of all head injuries presenting to Limerick Regional General Hospital in a single year. Data gathered included mechanism of injury, mode of transfer, requirement for admission and length of stay. Neurological status was assessed using the Glasgow Coma Scale (GCS) and functional status using the Glasgow Outcome Scale.


RESULTS
Between January and December 1995, 1,564 patients presented with head injuries to the accident and emergency (A/E) department of Limerick Regional General Hospital. Twenty (1%) were dead on arrival, 12% required hospital admission and the remainder were discharged after assessment. Seventy-six per cent were males and 74% under 40 years of age. Among the 194 patients requiring hospital admission, 14% had a skull fracture and 22 had a severe head injury. CT brain scans were performed in 43 patients and were abnormal in 42%. On the basis of CT and clinical findings, six patients were transferred immediately for a neurosurgical procedure and one was transferred later following clinical deterioration.


CONCLUSIONS
A CT scan and image-link facility permitting remote neurosurgical advice allows the majority of patients with head injury to be safely managed in well-equipped regional units without onsite neurosurgical expertise.
Eguare
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E
Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland.
Tierney
S
S
Barry
M C
MC
Grace
P A
PA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007494:Ireland; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed