Outcome of head injuries in general surgical units with an off-site neurosurgical service.
BACKGROUND
In order to cope with bed shortages in the only neurosurgical unit (NSU) in KwaZulu-Natal, it has become necessary to manage head injured patients in a general surgical unit (GSU) at the referral hospitals in consultation with the NSU. This study was undertaken to assess the outcome of patients with head injuries managed in a GSU in consultation with a regional NSU.


METHODS
A prospective pilot study was carried out in a single surgical unit over an 18-month period (July 1997-December 1998), followed by a larger prospective study over a 6-month period (January-June 2001). All patients with head injuries severe enough to warrant admission to hospital (GCS < or =15 or 15 with localising signs) were included.


RESULTS
The pilot study comprised 86 patients and the subsequent study comprised 230 patients, giving a total of 316 patients in the whole study. The mean age was 31 +/- 12 years. Following consultation with the NSU, 265 (84%) patients were managed in the GSU and 51 (16%) required transfer to the NSU. Forty-one patients died giving a mortality rate of 13%. Twenty eight of the 42 patients with GCS < or =8 died (67%) compared to 13 out of 274 with GCS >8 (5%) (p<0.0001). Eleven of the 51 patients destined to the NSU died (22%) compared to 30 of 265 in the GSU (11%) (p=0.046). The average hospital stay was 10 +/- 18 days. Forty surviving patients (17%) from the GSU and 20 from the NSU (51%) were discharged with neurological sequelae (p<0.001).


CONCLUSIONS
Head trauma is associated with high morbidity and mortality. Non-surgical treatment of traumatic brain injury at the referral hospital by the GSU is acceptable practice. Outcome is determined primarily by the GCS on presentation. NSU patients had a significantly higher mortality rate. A delay before surgery did not seem to affect outcome.
Zulu
B M W
BM
Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban, South Africa.
Mulaudzi
T V
TV
Madiba
T E
TE
Muckart
D J J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000458:organization & administration; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D019114:Remote Consultation; D013019:South Africa / Q000453:epidemiology; D019112:Teleradiology / Q000458:organization & administration*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014218:Triage / Q000379:methods