Direct versus indirect transfer for traumatic brain injury to James Cook University Hospital: a retrospective study

• Published in: Annals of the Royal College of Surgeons of England Vol. 103; no. 1; pp. 23 - 28
• Main Authors: Vats, A, Roy, D, Prasad, M K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2021; Royal College of Surgeons
• Subjects: Adolescent; Adult; Age; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - mortality; Brain Injuries, Traumatic - surgery; Brain research; Coma; Conservative Treatment - statistics & numerical data; Emergency Service, Hospital - standards; Emergency Service, Hospital - statistics & numerical data; Female; Fractures; Glasgow Coma Scale; Hospital Mortality; Hospitals, University - statistics & numerical data; Humans; Length of Stay; Male; Middle Aged; Mortality; Neurosurgery; Neurosurgery - statistics & numerical data; Neurosurgical Procedures - statistics & numerical data; Patient Transfer - standards; Patient Transfer - statistics & numerical data; Patients; Practice Guidelines as Topic; Retrospective Studies; Surgery; Surgery Department, Hospital - statistics & numerical data; Time Factors; Time-to-Treatment - standards; Time-to-Treatment - statistics & numerical data; Trauma Centers - standards; Trauma Centers - statistics & numerical data; Traumatic brain injury; Treatment Outcome; Young Adult; Glasgow Outcome Scale; Direct transfer; Indirect transfer; Length of hospital stay
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2020.0180

Patients with traumatic brain injury are referred to the neurosurgical unit at James Cook University Hospital, Middlesbrough, either from local accident and emergency departments (direct transfer from the scene) or from other hospitals (indirect transfer). This study looked at the outcome in both groups. This was a retrospective observational study using trauma audit research network data for patients treated for traumatic brain injury at the neurosurgery department at the neurosurgical unit at James Cook University Hospital. A total of 356 patients with traumatic brain injury were admitted under the care of neurosurgeons; 143 (40%) of these patients had a neurosurgical procedure. Of the patients undergoing a neurological procedure, 111 patients were transferred directly while 32 were indirect transfers; 213 patients were managed conservatively. Of those managed conservatively, 165 were transferred directly while 48 were indirect transfers. We compared the length of hospital stay and Glasgow Outcome Scale score for the patients based on whether they were conservatively managed or required surgery in the direct and indirect transfer groups. The difference in the length of stay in the surgical and conservative groups following direct and indirect transfer was insignificant ( = 0.07). The time to the operation in direct and indirect transfer was also not statistically significant ( = 0.06). Patients are as safe, if not safer, by reaching the nearest trauma unit with facilities for resuscitation and imaging.