The data suggest that too few patients are being offered surgical treatment for iNPH in Norway.

The purpose of this study was to survey the time consumed during the pre- and inter-hospital transport of severely head injured patients in Northern Norway. All patients (n = 85) operated for an intracranial mass lesions within 48 h after injury during the 10-year period 1986-1995 were included in this retrospective analysis. Ambulance records, transfer notes, and hospital records were reviewed. The transport of patients was classified as either direct from the trauma scene to the University Hospital (direct admission group) or as an inter-hospital transfer (transfer group). Forty-seven (55%) patients were in the direct admission group, and 38 (45%) were transferred through another hospital. The majority of patients (81%) were transported by air ambulance. Median time from injury to arrival in the emergency room was 5 (1-44) h. Time necessary for transport was significantly (p < 0.001) shorter in the direct admission group (median 3 h) compared to the transfer group (median 8 h). The inter-hospital transfer time was < or = 3 h in 17%. Clearly, the advanced air ambulance service in Northern Norway makes rapid inter-hospital transfer possible despite extremely long geographical distances. Our findings indicate that this possibility is not always utilized.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in Western countries. Effective management planning for these patients requires knowledge of TBI epidemiology. The purpose of this study was to describe and analyze the development of TBI mortality in the Nordic countries during the period 1987-2001. Data on TBI deaths were retrieved from the national official statistical agencies according to specified diagnostic codes. We also collected data on the number of operations for acute TBI in the year 2000 from all Nordic hospitals admitting trauma patients. Finland had about twice as high a TBI mortality rate as the other countries. Similarly, the Finnish incidence of acute TBI operations was nearly twice that of the other countries. The median TBI death rate for Finland was 21.2 per 100,000 per year, and for Denmark, Norway, and Sweden 11.5, 10.4, and 9.5, respectively. There were more male than female deaths in all countries. The mortality rate from extracranial injuries was relatively equal between the countries. We observed a sizeable reduction in TBI mortality rates for all countries, except in Finland. Younger age groups had the most pronounced decrease in TBI mortality rates. The oldest age group had the least favorable development of TBI mortality rates, and the mean age of TBI casualties increased substantially during the study period. This study demonstrates considerable differences in and between the Nordic countries regarding TBI mortality. Preventive measures and implementation of regional guidelines are needed to assure a positive development in the future.

We carried out a prospective study of the effect of neurosurgical teleconsultations on patient management in northern Norway. The total number of teleradiology image transfers during an eight-month study period was 723. We recorded data on 99 (14%) of these teleconsultations, which concerned 92 patients; the remainder were transfers to other departments at our hospital and transfers of routine examinations from a small community hospital that did not have a radiologist. The neurosurgeon on call noted the clinical condition and response time for each consultation. The consequences of the teleconsultation and the eventual benefits of the image transfer were evaluated. All 10 referring hospitals in the region used the service. The median response time was 3 hours (range 1-21 hours) in emergency cases and 1 day (range 1-7 days) in ordinary consultations. The response time was significantly shorter for patients with head injuries (median 3 hours) than for those with intracranial tumours (median 24 hours). Image transfer was considered beneficial for the patient in 93% of the cases. Avoidance of unnecessary patient transfer, changes of treatment at the referring hospital on the advice of the neurosurgeon and initiation of emergency transfer occurred in 34%, 42% and 13% of cases, respectively. The results confirm that teleconsultations between referring hospitals and a regional neurosurgical service influence patient management and reduce the frequency of patient transfer.

Old age is associated with fall-induced severe TBI and high mortality rates. Less intensive treatment strategies were applied to elderly patients in the present study despite high rates of haemorrhage. Few surviving elderly patients received rehabilitation at 3 months post-injury.