title: Comparison of mortality following hospitalisation for isolated head injury in England and Wales, and Victoria, Australia.
abstract: BACKGROUND
  Traumatic brain injury (TBI) remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE) guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes.
  
  
  METHODS
  Isolated TBI admissions (>15 years, July 2005-June 2006) were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3) admissions were provided by the Trauma Audit and Research Network (TARN) and Victorian State Trauma Registry (VSTR) for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions.
  
  
  RESULTS
  Mortality was 12% (749/6256) in England/Wales and 9% (91/1048) in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5), and for cases <65 years (OR 2.36, 95% CI: 1.51, 3.69). For severe TBI, mortality was 23% (133/575) for TARN and 20% (68/346) for VSTR, with 72% of TARN and 86% of VSTR cases managed at a neurosurgical centre. The adjusted mortality odds for severe TBI cases in TARN were higher compared to the VSTR (OR 1.45, 95% CI: 0.96, 2.19), but particularly for cases <65 years (OR 2.04, 95% CI: 1.07, 3.90). Neurosurgical centre management modified the effect overall (OR 1.12, 95% CI: 0.73, 1.74) and for cases <65 years (OR 1.53, 95% CI: 0.77, 3.03).
  
  
  CONCLUSIONS
  The risk-adjusted odds of mortality for all isolated TBI admissions, and severe TBI cases, were higher in England/Wales when compared to Victoria. The lower percentage of cases managed at neurosurgical centres in England and Wales was an explanatory factor, supporting the changes made to the NICE guidelines.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia. belinda.gabbe@monash.edu
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Lyons
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Maralyn
authors.initials: M
authors.lastname: Woodford
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D001315:Australia; D001930:Brain Injuries / Q000401:mortality; D006259:Craniocerebral Trauma / Q000401:mortality*; D004739:England; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014739:Victoria; D014852:Wales