Objective: This study compares injury severity and outcome of patients with severe head injury admitted directly to a neurosurgical department with those initially transferred to a local hospital.
Methods: A retrospective analysis of all patients with severe head injury admitted to the Department of Neurosurgery at St Olav University Hospital, Norway, was carried out from 1998 throughout 2002.
Results: The study included 146 patients with a median age of 34 (1-88) years. Patients transported directly (57%) had lower field Glasgow Coma Scale (fGCS) [5.5 (3-15) vs. 7 (3-15), P=0.002], higher Injury Severity Score [31.8 (9-75) vs. 27.0 (9-75), P=0.023], higher mortality rates (31 vs. 15%, P=0.042) and reached the neurosurgical department earlier [1.8 (0.3-15.8) vs. 5.5h (0.8-23.0), P<0.001] than those undergoing transfer to a local hospital. Significantly more patients in the direct admission group with a fGCS <or=8 (83%) were intubated at the scene of accident than in the transfer group (38%) (P<0.001). Multiple regression analysis adjusting for age, GCS and pupillary abnormalities did not predict increased mortality for the transfer group [odds ratio 0.43 (0.16, 1.14), P=0.09].
Conclusion: Patients with a severe head injury admitted directly to the neurosurgical department are more severely injured, more frequently get advanced medical treatment in the field, and are undergoing surgery earlier than transferred patients.