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

Abstract

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 <0.01). Interpretation: The reduction in odds of death following HI since 2003 is consistent with improved management following the introduction of national HI guidelines and increased treatment of SHI in NSUs.

Key words:

• Critical care
• neurosurgery
• craniocerebral trauma
• cohort studies
• patient transfer

Acknowledgements

We would like to thank the following participating hospitals in this study:

Addenbrooke's Hospital, Airedale General Hospital, Barnet Hospital, Barnsley District General Hospital, Basildon Hospital, Bedford Hospital, Birmingham Children's Hospital, Birmingham Heartlands Hospital, Blackpool Victoria Hospital, Bradford Royal Infirmary, Bristol Royal Hospital for Children, Bristol Royal Infirmary, Broomfield Hospital, Burnley General Hospital, Calderdale Royal Hospital, Charing Cross Hospital, Chase Farm Hospital, Chelsea Westminster Hospital, Chesterfield Royal Hospital, Chorley & South Ribble District General Hospital, City Hospital Birmingham, Colchester General Hospital, Conquest Hospital, Countess of Chester Hospital, Crawley Hospital, Croydon University Hospital, Cumberland Infirmary, Darent Valley Hospital, Darlington Memorial Hospital, Derriford Hospital, Dewsbury and District Hospital, Diana, Princess of Wales Hospital, Dorset County Hospital, Ealing Hospital, East Surrey Hospital, Eastbourne District General Hospital, Epsom General Hospital, Fairfield General Hospital, Frenchay Hospital, Friarage Hospital, Frimley Park Hospital, Furness General Hospital, Glan Clwyd Hospital, Good Hope Hospital, Grantham & District Hospital, Great Western Hospital Swindon, Harrogate District Hospital, Hereford County Hospital, Hillingdon Hospital, Hinchingbrooke Hospital, Homerton University Hospital, Hope Hospital, Huddersfield Royal Infirmary, Hull Royal Infirmary, Hurstwood Park Neuroscience Centre , Ipswich Hospital, James Cook University Hospital, James Paget Hospital, Jersey General Hospital, John Radcliffe Hospital, Kent & Canterbury Hospital, Kent & Sussex Hospital, King George Hospital, Kings College Hospital, King's Mill Hospital, Kingston Hospital, Leeds General Infirmary, Leicester Royal Infirmary, Leighton Hospital, Lincoln County Hospital, Lister Hospital, Luton & Dunstable Hospital, Macclesfield District General Hospital, Maidstone General Hospital, Manchester Royal Infirmary, Medway Maritime Hospital, Milton Keynes General Hospital, Morriston Hospital, Nevill Hall Hospital, Newcastle General Hospital, Newham General Hospital, Norfolk & Norwich University Hospital, North Hampshire Hospital, North Manchester General Hospital, North Middlesex Hospital, North Tyneside General Hospital, Northampton General Hospital, Northern General Hospital, Northwick Park Hospital, Nottingham University Hospital, Peterborough District Hospital, Pilgrim Hospital, Pinderfields General Hospital, Pontefract General Infirmary, Poole Hospital, Prince Charles Hospital, Princess of Wales Hospital, Queen Alexandra Hospital, Queen Elizabeth Hospital Birmingham, Queen Elizabeth Hospital Gateshead, Queen Elizabeth Hospital Kings Lynn, Queen Mother Hospital, Queen's Hospital Essex, Rochdale Infirmary, Royal Albert Edward Infirmary, Royal Berkshire Hospital, Royal Blackburn Hospital, Royal Bolton Hospital, Royal Bournemouth Hospital, Royal Cornwall Hospital, Royal Derby Hospital, Royal Devon & Exeter Hospital, Royal Free Hospital Royal Glamorgan Hospital, Royal Gwent Hospital, Royal Hallamshire Hospital, Royal Lancaster Infirmary, Royal Liverpool Childrens Hospital (Alder Hey), Royal Liverpool University Hospital, Royal London Hospital, Royal Manchester Children's Hospital, Royal Oldham Hospital, Royal Preston Hospital, Royal Shrewsbury Hospital, Royal Surrey County Hospital, Royal Sussex County Hospital, Royal United Hospital, Salisbury District Hospital, Sandwell General Hospital, Scarborough Hospital, Scunthorpe General Hospital, Sheffield Children's Hospital, South Tyneside District Hospital, Southampton University Hospital, Southend Hospital, Southport & Formby District General Hospital, St George's Hospital, St Helier Hospital, St James' University Hospital, St Mary's Hospital Isle of Wight, St Mary's Hospital London, St Peters Hospital Chertsey, St Thomas' Hospital, Stepping Hill Hospital, Stoke Mandeville Hospital, Sunderland Royal Hospital, Tameside General Hospital, Torbay Hospital, Trafford General Hospital, University College Hospital, University Hospital Aintree, University Hospital Lewisham, University Hospital of Coventry and Warwickshire, University Hospital of Hartlepool, University Hospital of North Staffordshire, University Hospital of North Tees, University Hospital of Wales, Walton Centre for Neurology, Wansbeck General Hospital, Warrington Hospital, West Cumberland Hospital, West Middlesex University Hospital, West Suffolk Hospital, West Wales General Hospital, Wexham Park Hospital, Whipps Cross University Hospital, Whiston Hospital, Whittington Hospital, William Harvey Hospital, Wirral University Teaching Hospital, Withybush General Hospital, Worthing Hospital, Wrexham Maelor Hospital, Wythenshawe Hospital, York Hospital, Ysbyty Gwynedd District General.