Management of head injury in a regional hospital

Background Concern about delay in the treatment of serious head injury may result in unnecessary transfer to neurosurgical units for scanning and neur osurgical assessment. Aims This study assessed the management of head injuries in a regional hosp ital with computed tomographic (CT) and 'image-link' facilities allowing in stantaneous transmission of CT scans to the regional neurosurgical unit for specialist assessment. Methods A retrospective study was carried out of all head injuries presenti ng to Limerick Regional General Hospital in a single year. Data gathered in cluded mechanism of injury, mode of transfer, requirement for admission and length of stay. Neurological status was assessed using the Glasgow Coma Sc ale (GCS) and functional status using the Glasgow Outcome Scale Results Between January and December 1995, 1,564 patients presented with he ad injuries to the accident and emergency (A/E) department of Limerick Regi onal General Hospital. Twenty (1%) were dead on arrival, 12% required hospi tal admission and the remainder were discharged after assessment. Seventy-s ix per cent were males and 74% under 40 years of age. Among the 194 patient s requiring hospital admission, 14% had a skull fracture and 22 had a sever e head injury. CT brain scans were performed in 43 patients and were abnorm al in 42%. On the basis of CT and clinical findings, six patients were tran sferred immediately for a neurosurgical procedure and one was transferred l ater following clinical deterioration. Conclusions A CT scan and image-link facility permitting remote neurosurgic al advice allows the majority of patients with head injury to be safely man aged in well-equipped regional units without onsite neurosurgical expertise .