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Severe head injury in children: geographical range of an emergency neurosurgical practice

R C Tasker1, S Gupta, D K White

  • 1Paediatric Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. rct31@cam.ac.uk

Emergency Medicine Journal : EMJ
|June 23, 2004
PubMed

Insights

Timely emergency neurosurgery for severe head injuries in children is challenging. Current regional transfer times suggest the four-hour surgical guideline is unworkable beyond a 45-minute travel radius.

Area of Science:

  • Pediatric Neurosurgery
  • Trauma Care
  • Health Services Research

Background:

  • Severe head injury in children necessitates prompt neurosurgical intervention.
  • Regionalized care models aim to optimize access to specialized pediatric intensive care unit (PICU) and surgical services.
  • Guidelines recommend acute neurosurgery within four hours of injury for specific conditions like hematoma evacuation.

Purpose of the Study:

  • To evaluate the actual timings of regional transfers for pediatric emergency neurosurgery and intensive care.
  • To determine the effective operational range of a regional neurosurgical service for severe head injuries in children.

Main Methods:

  • Prospective observational study involving 69 children with severe head injuries admitted to a regional PICU.
  • Data collected on time intervals from injury to initial hospital arrival (primary transfer) and from first hospital arrival to PICU/OR (secondary transfer).
  • Study conducted in the East Anglia region, UK, over two years, with 18 referring hospitals within a two-hour road transit time.

Main Results:

  • Median time from accident to first hospital arrival was 48 minutes.
  • Median secondary transfer time to PICU/OR was 4.4 hours after initial hospital admission.
  • Achieving surgery within four hours of injury was rare, requiring a service range limited to approximately 45 minutes road transit time.

Conclusions:

  • Evidence supporting the feasibility of the four-hour neurosurgical intervention guideline for severe head-injured children is limited.
  • Current regional transfer timings indicate the guideline is impractical for areas exceeding a 45-minute road travel time from the specialized center.
  • Optimization of regional trauma networks is needed to improve timely access to critical pediatric neurosurgical care.
Abstract

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