Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study.
BACKGROUND
Case fatality rates after all types of blunt injury have not improved since 1994 in England and Wales, possibly because not all patients with severe head injury are treated in a neurosurgical centre. Our aims were to investigate the case fatality trends in major trauma patients with and without head injury, and to establish the effect of neurosurgical care on mortality after severe head injury.


METHODS
We analysed prospectively collected data from the Trauma Audit and Research Network database for patients presenting between 1989 and 2003. Mortality and odds of death adjusted for case mix were compared for patients with and without head injury, and for those treated in a neurosurgical versus a non-neurosurgical centre.


RESULTS
Patients with head injury (n=22,216) had a ten-fold higher mortality and showed less improvement in the adjusted odds of death since 1989 than did patients without head injury (n=154,231). 2305 (33%) of patients with severe head injury (presenting between 1996 and 2003) were treated only in non-neurosurgical centres; such treatment was associated with a 26% increase in mortality and a 2.15-fold increase (95% CI 1.77-2.60) in the odds of death adjusted for case mix compared with patients treated at a neurosurgical centre.


CONCLUSIONS
Since 1989 trauma system changes in England and Wales have delivered greater benefit to patients without head injury. Our data lend support to current guidelines, suggesting that treatment in a neurosurgical centre represents an important strategy in the management of severe head injury.
Patel
H C
HC
Department of Neurosurgery, Hope Hospital, Salford, UK.
Bouamra
O
O
Woodford
M
M
King
A T
AT
Yates
D W
DW
Lecky
F E
FE
D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000145:classification / Q000401:mortality* / Q000601:surgery; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000401:mortality*