Analysis of prehospital transport of head-injured patients after consolidation of neurosurgery resources.
OBJECTIVE
Consolidation of neurosurgical (NS) services resulted in emergency medical services guidelines mandating transport of head-injured patients to the NS center if the Glasgow Coma Scale score is < 14 and prehospital index is > 3. This study determined what paramedic, system, or patient factors were associated with secondary head-injury transfer.


METHODS
This study was a retrospective chart review from January 1996 to November 1998.


RESULTS
Ninety-one patient charts were reviewed. The median transport delay to the NS site was 4 hours 22 minutes. After transfer, 79 (96%) patients were admitted, 25 (30%) underwent craniotomy, and 18 (22%) died. The final diagnosis in 35 (43%) cases was subdural hematoma. Triage guidelines were violated in five patients (6%) and the NS center was on diversion in three (4%) cases. Most delays were related to patient presentations; 17 (21%) patients had no history of head trauma.


CONCLUSIONS
Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.
Holmen
Carol D
CD
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. cholmen@ualberta.ca
Sosnowski
Terry
T
Latoszek
Karen L
KL
Dow
Darryl
D
Rowe
Brian H
BH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006754:Hospital Restructuring; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*