Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

Abstract

ObjectivesTo provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units.DesignThe Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015.SettingData were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14n) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed.ResultsWe identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot.ConclusionsWe provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales.

Traumatic Penumbra: Opportunities for Neuroprotective and Neurorestorative Processes

“…Based on GCS, TBI is classified into mild (GCS score [14][15], moderate (9)(10)(11)(12)(13), and severe (3-8) [15]. At present, GCS is the most used method for TBI classification, however, has a number of limitations [15,16].…”

“…TBI affects individuals of all age groups with a bimodal distribution in adolescents and elderly [8,9], with a major predominance in the male population [10,11]. Blunt trauma accounts for about 88-95% of TBI cases, whereas the remaining 5-12% of cases are the result of penetrating injuries [12].…”

Sugar or salt (“SOS”): A protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

“…2 Resource use in these patients is high with an average length of stay in ICU of nine days. 2 Long-term outcomes from TBI remain poor -with reported mortality as high as 26% at six months and significant disability in survivors. 3 Following TBI, intracranial pressure (ICP) may be increased by a mass effect from intracranial haematomas, contusions, diffuse brain swelling, or hydrocephalus.…”

Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench

“…[15] Within these groups, surgical decompression via craniotomy or craniectomies are performed emergently in between 2–14% of patients depending on the severity of brain injury and, subsequently, delayed, secondary reconstructions may occur following resolution of cerebral edema. [16] In 1 in 2500 children, congenital anomalies of the skull such as craniosynostosis occurs. [17] Additionally, 1 in 700 children are affected by facial clefts, of which the rarest clefts usually affect both the skull and the face.…”