Objectives and Background To develop a streamlined referral pathway for isolated head injuries in Trauma Units. Severe head injury (ISS >15) is a major problem in the UK. For 2010, TARN data shows 21 192 submissions, of these 7521 had an ISS >15 and 5086 were AIS 3+ in the head. Current recommendations are that all patients' GCS <9 are taken to a Major Trauma Centre giving rapid access to Neurosurgery and improving outcome. The development of integrated trauma systems is addressing this but despite the presence of primary bypass in the pre-hospital arena, under-triaged patients arrive in Trauma Units. These need rapid referral by secondary “hot” transfer protocols. The system works well for patients with polytrauma; however isolated head injuries are still not being transferred rapidly.
Methods Six months of data in the TARN report (February 2011) was reviewed for all patients ISS >15. Outcome at 3 and 30 days, discussions with Neurosurgeons, and subsequent transfers were determined. Time to CT was compared for all ISS >15, those meeting NICE head injury guidelines, and isolated head injury patients.
Results 60% of ISS >15 patients were isolated head injuries. 29% died within 30 days, 26% within 3 days. 74% of all patients were discussed with the neurosurgeons (82% of isolated head injuries) and 13% transferred. Median time to CT was 2.2 h (IQR 1.2–12.1) for all, 2.2 h (1.2–5.95) if meeting NICE guidelines and 1.8 h (1.1–7.5) for isolated head injuries.
Conclusions The major barriers to referral seem to be time to CT scanning and the level of “gate-keeping” at neurosurgical level. We believe the simplified neurosurgical referral pathway will give our isolated head injury patients the same rapid referral as our polytrauma patients.
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