An issue in the design of trials in traumatic brain injury is whether varia
tion amongst centres in 'conventional' management could mask the impact of
a powerful new pharmacological agent. We report the results of an observati
onal study of 988 patients admitted to one of four British neurosurgical un
its between 1986 and 1988 within 3 days of a severe head injury. The centre
s fell into two pairs on the basis of the 'intensity' of management. In Edi
nburgh and Southampton, more frequent use of intracranial pressure monitori
ng, ventilation and osmotic diuretics was made than in Glasgow and Liverpoo
l. The odds ratio for an independent outcome at 6 months in Edinburgh or So
uthampton, relative to Glasgow or Liverpool, controlling for case mix, was
1.43 (95% CI, 1.03-1.98, p = 0.033). Thus, there is weak evidence of an ass
ociation between the approach to management and clinical outcome at 6 month
s.