Management and outcomes of patients with brain trauma in a tertiary referral trauma hospital without neurosurgeons on site

Waikato Hospital is a tertiary hospital of over 700 beds receiving large nu mbers of trauma patients, but has no neurosurgeon. closer than 130 kilometr es. Over the IO yeats ending July 1997, 831 cases of brain trauma were admi tted to the Intensive Care Unit. Of these, 191 died before leaving hospital (overall mortality 23%). Of the 547 who had a Glasgow Coma Score (GCS) les s than or equal to 8, 173 died (mortality 32%). Of the children who were <1 5 years of age and had a GCS less than or equal to 8, there was a 23% morta lity. These mortality rates are acceptable when compared with other repents (average 37% over 12 adult series). Using brain AIS scores, our mortality figures also compared favourably with those in the literature, and suggest that the quality of brain trauma care is adequate in this non-neurosurgical centre with intensive care, backed by CT scanning and general surgeons abl e to do urgent burr holes. Six per cent of the brain trauma patients (appro ximately five per year), required interhospital transfer for definitive neu rosurgical care.