Snapshot view of emergency neurosurgical head injury care in Great Britainand Ireland

Objectives-To study the availability of neurosurgical intensive care for th e traumatically brain injured in all 36 neurosurgical centres in the United Kingdom and Ireland receiving head injuries, the response times to referra l, and the advice given to the referring hospitals. Methods-Telephone survey of receiving neurosurgeons regarding their bed sta tus and their advice on three hypothetical case scenarios. Outcome measures included response times for an acute head injury to be accepted to a neuro surgical centre; the intensive care bed status; variations in advice given to the referring hospitals with regard to ventilation, use of mannitol, ste roids, anticonvulsants, and antibiotics. Results-There were 43 neurosurgical intensive care beds available for an Th ere were 1.8 beds available/million of the population for nonventilated pat ients, 0.64 beds available/million for ventilated patients, and 0.55 beds a vailable/million for ventilated paediatric patients. London had a shortage of beds with 0.19 adult beds for ventilation/million north of the Thames an d 0.14 adult beds for ventilation/million south of the Thames. The median r esponse time for a patient with an extradural haematoma to be accepted for transfer was 6 minutes and 89% of such a referral was accepted within 30 mi nutes. Clinically significant delays in receiving referrals (over 30 minute s) occurred in four units. Practices regarding the use of hyperventilation, mannitol, anticonvulsants, and antibiotics showed little conformity and in some cases were against the available evidence and advice given by publish ed guidelines. Conclusions-There is a severe shortage of available emergency neurosurgical beds especially in the south east of England. The lack of immediately avai lable neurosurgical intensive care beds ventilated patients, 0.64 beds avai lable England. The lack of immediately available neurosurgical intensive ca re beds results in delays of transfer that could adversely affect the outco me of surgery for traumatic intracranial haematoma. Advice given to the ref erring units by the receiving doctors is very variable.