NCEPOD: Trauma - Who Cares? - London Health Programmes

8Head injury managementtimely in 68/81 (84.0%). Of the 16% of cases where it wasfelt that surgery was not performed in a timely manner, 10/13required evacuation of clots or craniectomies where delaysare undesirable and have a negative impact on outcome(Table 90).This delay is in keeping with a recent study which showedthat the mean transfer time to a neurosurgical centre forpatients with an extradural haematoma and subduralhaematoma was 5.25 and 6 hours respectively 33 .Clearly these delays may affect outcome and this againraises the issue of transfer to an appropriate hospital inthe fi rst instance and reconfi guration of trauma servicesfor regions.Table 90. Timeliness of neurosurgeryNumber of patients %Yes 68 84.0No 13 16.0Subtotal 81Insuffi cient data 33Total 114Overall assessment of management of headinjured patientsThe advisors were asked to assess the overall managementof the patient using the grading system detailed in themethods section (Table 91).Table 91. Overall assessment ofhead injury managementNumber ofpatientsGood practice 205 41.6Room for improvement clinical 80 16.2Room for improvement organisational 114 23.1Room for improvement clinical and 46 9.3organisationalLess than satisfactory 25 5.1Insuffi cient data 23 4.7Total 493Less than half the patients (205/493) were thought to havereceived a standard of care that could be described as goodpractice. In 240/493 (48.7%) cases it was thought that therewas room for improvement in organisational and /or clinicalaspects of care. Of concern were the 25/493 (5.1%) caseswhere it was thought that patient management was lessthan satisfactory, signifying a signifi cant problem in thecare process.%107