Transfer of head-injured patients in Jamaica: is there a problem?

Head-injured patients are often transferred to the University Hospital of the West Indies (UHWI) for tertiary care. There is no standardized, agreed protocol governing their transfer. During the three-year period January 1998 to December 2000, 144 head injured patients were transferred to the UHWI from other institutions. They were 70% male, had a mean age of 34 years and spent a mean of 13 days in hospital. Eighteen per cent were admitted to the Intensive Care Unit, where they spent a mean of nine days. On arrival, mean pulse rate was 92 +/- 22 beats/minute, mean systolic blood pressure was 130 +/- 27 mmHg and mean diastolic was 76 +/- 19mmHg. Twenty-eight per cent of patients had a pulse rate above 100/min on arrival and 13.8% had systolic blood pressure below 60 mmHg. The Glasgow Coma Scale score was unrecorded at the referring institution in 70% of cases and by the receiving officers at the UHWI in 23% of cases. Intubation was done on only half of those who were eligible. Junior staff members initiated and carried out transfers whenever this was documented. The types of vehicles and monitoring equipment used could not be determined in most instances. Fifty-eight per cent of patients had minor head injuries, 12%, severe injury and 33%, associated injuries requiring a variety of surgical procedures by multiple specialties. Most patients (80.6%) were discharged home but 11.8% died in hospital. Transfer of head-injured patients, many with multiple injuries is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardized protocol for the transfer of such patients in Jamaica.