The work of a regional head injury service

A survey was done of the workload involved in conducting a programme in which all degrees of severity of head injury are managed in one unit staffed by neurosurgeons. Of 1919 patients admitted to the unit in 1981, 93 were classed as severe (in coma), 210 as moderate, and 1616 as minor (fully conscious or confused only) on admission. Although the proportion of intracranial haematomas, multiple injuries, life-threatening complications, and deaths was highest in severe cases, the work of looking after the very large numbers of moderate and minor cases was as great as that of looking after severe cases as defined by number of investigations, operations, and complications, morbidity, and duration of hospital stay. In 1982 the admission policy was changed so that temporary loss of consciousness was no longer an indication for admission. This change resulted in a 24% reduction in number of admissions. Seat-belt legislation, enacted early in 1983, was followed by a further 21% reduction in the admission rate and this was maintained in 1984. Not all of this latter reduction can, however, be attributed to the wearing of seat belts.