Time to definitive care for patients with moderate and severe traumatic brain injury--does a trauma system matter?

The presence of a trauma system has been associated with improved outcomes in patients with traumatic brain injury (TBI) by speeding up transfers to a neurosurgical centre. Improved outcomes are associated with time to neurosurgical intervention for those with significant extradural and subdural haemorrhages of less than 4 hours. To compare the outcomes for patients with TBI transferred directly from the scene of injury to Auckland City Hospital (ACH) with those transferred from other hospitals, transfer times and outcomes were evaluated in a consecutive cohort of patients recorded on the ACH trauma registry.

Patients admitted to ACH in 2004 and recorded on the trauma registry with a moderate or severe head injury (Abbreviated Injury Scale (AIS) score of 3 or greater) were included. The primary outcomes assessed were median time from injury to arrival and surgery, patient mortality, length of ICU stay and length of hospital stay.

198 patients were admitted at ACH in 2004 with moderate and severe TBI. 95 patients (48%) were transferred from another hospital. Patients transported to ACH from the scene of injury arrived to ACH and underwent neurosurgery within a mean of 3 hours 50 minutes, whereas patients transferred from another hospital took significantly longer than 4 hours to arrive at ACH. Patients transferred from another hospital had similar mortality rate, length of ICU stay and length of hospital stay to those admitted directly.

TBI patients who were transferred from another hospital arrived well outside the recommended guidelines. While no significant difference in outcome was noted in this small cohort of patients further studies are warranted. The development of a national trauma registry would allow accumulation of data on larger numbers of patients and determine the true relevance of international best practice guidelines in New Zealand.