NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 8 - Head injury managementTable 84. The specialty of the clinician interpretingthe CT scanNumber of patients %Radiology 312 94.8Emergencymedicine10 3.0Neurology 6 1.8Anaesthetics 1
8Head injury managementFigure 44. Location of consulted neurosurgeon60Number of patients5040302010OnsiteOffsiteNot documented015 13-14 09-12 04-08 03 Not recordedGlasgow Coma ScoreFigure 43 shows data on whether there was discussion withthe neurosurgical service. In the majority of cases where apatient suffered a head injury, a neurosurgical consultationwas performed. However, it was noted that 44/271 (16.2%)patients with moderate or severe head injuries had noevidence of neurosurgical involvement. Within this groupof 44 patients it is possible that consultation was notundertaken due to the extent of head and/or other injuriesleading to the conclusion that death was inevitable.As part of the peer review process, advisors were askedwhether a neurosurgical consultation was a necessary part ofeach individual case. Of the 155 cases where there was noevidence of neurosurgical involvement the advisors felt thatthis should have occurred in 28 cases (18.1%).Location of neurosurgical supportFigure 44 shows the location of the neurosurgical service inrelation to the admission location. More patients receivedoffsite neurosurgical support than onsite.These data suggest that 197/365 (54.0%) patients whorequired neurosurgical involvement were taken to hospitalsthat may not have had the necessary infrastructure (on siteneurosurgical expertise) to meet their needs. Given thetime critical nature of neurosurgical intervention in traumaticbrain injury this had the potential to introduce delaysinto defi nitive management, which may affect outcome.Although we accept that in many circumstances takingthe patient directly to a neurosurgical centre may be moreappropriate, consideration of the pattern and severity ofinjuries and the likely services required should be taken intoaccount when the prehospital clinicians are transportingthe severely injured patient to hospital. However, it doesappear that direct admission to a trauma centre compared tosecondary transfer is associated with a better outcome 25 andneurosurgeons and ambulance trusts should agree protocolson this aspect of care.103
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
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ForewordSevere injury - a car crash
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Summary of fi ndingsThis study show
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Principal recommendationsOrganisati
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IntroductionTrauma remains the four
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IntroductionReferences1. Chaira 0,
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MethodQuestionnaires and casenotesT
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MethodQuality and confidentialityA
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CHAPTER 1 - Data overviewFigure 2.
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CHAPTER 1 - Data overviewMode of ar
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CHAPTER 2 - Organisational dataTabl
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CHAPTER 3 - Overall assessmentAll c
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CHAPTER 3 - Overall assessmentKey f
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CHAPTER 4 - Prehospital careRespons
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CHAPTER 4 - Prehospital careFigure
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CHAPTER 4 - Prehospital careTranspo
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CHAPTER 4 - Prehospital careAdequac
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CHAPTER 4 - Prehospital careIn 40/5
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CHAPTER 4 - Prehospital carecaused
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CHAPTER 5 - Hospital receptionIntro
Page 54 and 55: CHAPTER 5 - Hospital receptionTable
Page 56 and 57: CHAPTER 5 - Hospital receptionTraum
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Page 60 and 61: CHAPTER 5 - Hospital receptionThese
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Page 64 and 65: CHAPTER 6 - Airway and breathingInt
Page 66 and 67: CHAPTER 6 - Airway and breathingFig
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Page 72 and 73: CHAPTER 7 - Management of circulati
Page 88 and 89: CHAPTER 8 - Head injury managementI
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Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
Page 118 and 119: CHAPTER 9 - Paediatric careKey find
Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
Page 122 and 123: CHAPTER 10 - TransfersArrangement o
Page 124 and 125: CHAPTER 10 - TransfersFigure 52. De
Page 126 and 127: CHAPTER 10 - TransfersKey findingsR
Page 128 and 129: CHAPTER 11 -Incidence of trauma and
Page 130 and 131: CHAPTER 11 - Incidence of trauma an
Page 136 and 137: APPENDIX B - Injury severity scoreA
Page 138 and 139: APPENDIX C - Adult and paediatric G
Page 140 and 141: APPENDIX D - An example of an excel
Page 142 and 143: APPENDIX E - Level 1 trauma careAs
Page 144 and 145: APPENDIX F - ParticipationTrustCase
Page 150 and 151: APPENDIX G - Corporate structureThe
Page 152: Published November 2007 by the Nati
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