Temporal trends in head injury outcomes from 2003 to 2009 in England and Wales

Background: Case fatality rates after blunt head injury (HI) did not improve in England and Wales between 1994 and 2003. The United Kingdom National Institute of Clinical Excellence subsequently published HI management guidelines, including the recommendation that patients with severe head injuries...

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Bibliographic Details
Published in:British journal of neurosurgery 2011-06, Vol.25 (3), p.414-421
Main Authors: Fuller, G., Bouamra, O., Woodford, M., Jenks, T., Patel, H., Coats, T. J, Oakley, P., Mendelow, A.D., Pigott, T., Hutchinson, P. J, Lecky, F.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Cohort Studies
craniocerebral trauma
Craniocerebral Trauma - mortality
Critical care
Disease management
England - epidemiology
Female
Head injuries
Humans
Injury Severity Score
Male
Middle Aged
Mortality
Mortality - trends
Neurosurgery
patient transfer
Retrospective Studies
Studies
Wales - epidemiology
Wounds, Nonpenetrating - mortality
Young Adult
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Summary:Background: Case fatality rates after blunt head injury (HI) did not improve in England and Wales between 1994 and 2003. The United Kingdom National Institute of Clinical Excellence subsequently published HI management guidelines, including the recommendation that patients with severe head injuries (SHIs) should be treated in specialist neuroscience units (NSU). The aim of this study was to investigate trends in case fatality and location of care since the introduction of national HI clinical guidelines. Methods: We conducted a retrospective cohort study using prospectively recorded data from the Trauma and Audit Research Network (TARN) database for patients presenting with blunt trauma between 2003 and 2009. Temporal trends in log odds of death adjusted for case mix were examined for patients with and without HI. Location of care for patients with SHI was also studied by examining trends in the proportion of patients treated in non-NSUs. Results: Since 2003, there was an average 12% reduction in adjusted log odds of death per annum in patients with HI (n=15,173), with a similar but smaller trend in non-HI trauma mortality (n=48,681). During the study period, the proportion of patients with HI treated entirely in non-NSUs decreased from 31% to 19%, (p
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2011.570882