Treatment of extradural haemorrhage in Queensland: interhospital transfer, preoperative delay and clinical outcome.
OBJECTIVE
To measure preoperative delays and clinical outcomes of patients with extradural haemorrhage, comparing patients presenting to hospitals with no neurosurgical facilities, with those presenting directly to neurosurgical centres.


METHODS
Retrospective case study with data collected from 10 centres. Patients were identified with a search of the Queensland Trauma Registry database. A total of 315 charts were reviewed, of patients presenting or referred to Queensland's public hospitals between 2002 and 2004 inclusive.


RESULTS
A total of 261 patients were included in the study. One hundred and fifty-nine patients presented to hospitals with no neurosurgical facilities; 102 presented directly to neurosurgical centres. Forty-six patients underwent interhospital transfer (IHT) before decompressive craniotomy; their median time interval from presentation to operation was 8 h 5 min. This delay was significantly greater than that for 25 patients admitted directly to neurosurgical centres (median 4 h 19 min; P = 0.0006). After excluding patients who had sustained hypoxic or hypotensive insults or serious extracranial injuries, all deaths (five) occurred in patients undergoing IHT before craniotomy.


CONCLUSIONS
IHT of patients with extradural haemorrhage causes significant preoperative delay.
Deverill
Jo
J
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), University of Queensland, Brisbane, Queensland, Australia. jodeverill@mac.com
Aitken
Leanne M
LM
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000628:therapy*; D006767:Hospitals, District / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000592:standards; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data*; D011793:Queensland / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome