Head injuries in four British neurosurgical centres

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.