EFFICIENT TIMELY EVACUATION OF INTRACRANIAL HEMATOMA - THE EFFECT OF TRANSPORT DIRECT TO A SPECIALIST CENTER

Patients with intracranial haematoma following head injury may have li ttle primary brain injury, but sustain a secondary brain injury that c all often be minimized by early evacuation of the haematoma. Rapid int ervention by a neurosurgeon with early evacuation of the haematoma giv es a better,outcome. The timing of treatment in 403 patients with seve re head injuries, admitted to the Royal London Hospital between Januar y 1991 and December 1994 was examined. All cases had been transported directly from the accident scene by the Helicopter Emergency Medical S ervice because the local hospital did not have neurosurgical facilitie s. The median time to medical intervention was 15 min (95 per cent, co nfidence interval (CI) 14-16) and the median time to neurosurgery was 177 mill (95 per cent, CI 171-195). As secondary interhospital transfe r of patients with head injuries is known to increase the time to neur osurgical intervention and is a time of great risk of secondary insult to the brain; transfer direct from the scene of tile accident to nit appropriate centre allows a process df care that has been shown to be associated with a better outcome. (C) 1997 Elsevier Science Ltd.