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In patients with suspected head injuries, the immediate purpose of a specific diagnosis is to determine which patients need an emergency or urgent neurosurgical operation. The teaching is that within two hours of injury, essential diagnostic studies should be completed, as delay can be extremely costly for the patient. In view of this emergency CT scans should be obtained as soon as possible ideally within 30 minutes after the injury.1
Hospitals that transfer patients often have difficulties determining areas of delay. With this in mind, we decided to carry out a prospective study of all head injury patients with a GCS of <13 who required transfer. Our main objective was to determine the arm of greatest delay.
The period in question was January to June 2002. The total number of transfers during this period was 19. Of this number 11 were traumatic head injuries and 8 were non-traumatic (SAH).
The total time from arrival to disposal was a mean time of 227 minutes. Arrival time to scan had a mean of 32 minutes and scan to disposal had a mean time of 104 minutes however there was a considerable difference between traumatic head injury cases (135 minutes) and non-traumatic head injuries (59 minutes).
From the results, the greatest arm of delay lies in the disposal of the patient after CT. This was especially the case where the patient had sustained traumatic head injury. Closer scrutiny showed that when it was a traumatic injury, there was almost universal insistence on seeing the scans before accepting the patient often resulting in taxi transfer of images.
The study raises some questions:
Why see the scans images before sanctioning a transfer? Are there concerns relating to the radiologist’s interpretation of the scans?
Should it be a matter of policy that all isolated severe head injuries (GCS <8) be taken directly to the neurosurgical centres?
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