title: Temporal trends in head injury outcomes from 2003 to 2009 in England and Wales.
abstract: BACKGROUND
  Case fatality rates after blunt head injury (HI) did not improve in England and Wales between 1994 and 2003. The United Kingdom National Institute of Clinical Excellence subsequently published HI management guidelines, including the recommendation that patients with severe head injuries (SHIs) should be treated in specialist neuroscience units (NSU). The aim of this study was to investigate trends in case fatality and location of care since the introduction of national HI clinical guidelines.
  
  
  METHODS
  We conducted a retrospective cohort study using prospectively recorded data from the Trauma and Audit Research Network (TARN) database for patients presenting with blunt trauma between 2003 and 2009. Temporal trends in log odds of death adjusted for case mix were examined for patients with and without HI. Location of care for patients with SHI was also studied by examining trends in the proportion of patients treated in non-NSUs.
  
  
  RESULTS
  Since 2003, there was an average 12% reduction in adjusted log odds of death per annum in patients with HI (n=15,173), with a similar but smaller trend in non-HI trauma mortality (n=48,681). During the study period, the proportion of patients with HI treated entirely in non-NSUs decreased from 31% to 19%, (p <0.01).
  
  
  CONCLUSIONS
  The reduction in odds of death following HI since 2003 is consistent with improved management following the introduction of national HI guidelines and increased treatment of SHI in NSUs.
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Salford, M6 8HD, UK. gordonwfuller@doctors.net.uk
authors.forename: G
authors.initials: G
authors.lastname: Fuller
authors.forename: O
authors.initials: O
authors.lastname: Bouamra
authors.forename: M
authors.initials: M
authors.lastname: Woodford
authors.forename: T
authors.initials: T
authors.lastname: Jenks
authors.forename: H
authors.initials: H
authors.lastname: Patel
authors.forename: T J
authors.initials: TJ
authors.lastname: Coats
authors.forename: P
authors.initials: P
authors.lastname: Oakley
authors.forename: A D
authors.initials: AD
authors.lastname: Mendelow
authors.forename: T
authors.initials: T
authors.lastname: Pigott
authors.forename: P J
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: F
authors.initials: F
authors.lastname: Lecky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies; D014852:Wales / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality*; D055815:Young Adult