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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jan;68(1):8–13. doi: 10.1136/jnnp.68.1.8

Snapshot view of emergency neurosurgical head injury care in Great Britain and Ireland

D Crimmins 1, J Palmer 1
PMCID: PMC1760592  PMID: 10601392

Abstract

OBJECTIVES—To study the availability of neurosurgical intensive care for the traumatically brain injured in all 36 neurosurgical centres in the United Kingdom and Ireland receiving head injuries, the response times to referral, and the advice given to the referring hospitals.
METHODS—Telephone survey of receiving neurosurgeons regarding their bed status and their advice on three hypothetical case scenarios. Outcome measures included response times for an acute head injury to be accepted to a neurosurgical centre; the intensive care bed status; variations in advice given to the referring hospitals with regard to ventilation, use of mannitol, steroids, anticonvulsants, and antibiotics.
RESULTS—There were 43 neurosurgical intensive care beds available for an overall estimated population of 63.6 million. There were 1.8 beds available/million of the population for non-ventilated patients, 0.64 beds available/million for ventilated patients, and 0.55 beds available/million for ventilated paediatric patients. London had a shortage of beds with 0.19 adult beds for ventilation/million north of the Thames and 0.14 adult beds for ventilation/million south of the Thames. The median response time for a patient with an extradural haematoma to be accepted for transfer was 6 minutes and 89% of such a referral was accepted within 30 minutes. Clinically significant delays in receiving referrals (over 30 minutes) occurred in four units. Practices regarding the use of hyperventilation, mannitol, anticonvulsants, and antibiotics showed little conformity and in some cases were against the available evidence and advice given by published guidelines.
CONCLUSIONS—There is a severe shortage of available emergency neurosurgical beds especially in the south east of England. The lack of immediately available neurosurgical intensive care beds results in delays of transfer that could adversely affect the outcome of surgery for traumatic intracranial haematoma. Advice given to the referring units by the receiving doctors is very variable.



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Selected References

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  1. Bartlett J., Kett-White R., Mendelow A. D., Miller J. D., Pickard J., Teasdale G. Recommendations from the Society of British Neurological Surgeons. Br J Neurosurg. 1998 Aug;12(4):349–352. doi: 10.1080/02688699844871. [DOI] [PubMed] [Google Scholar]
  2. Brocklehurst G., Gooding M., James G. Comprehensive care of patients with head injuries. Br Med J (Clin Res Ed) 1987 Feb 7;294(6568):345–347. doi: 10.1136/bmj.294.6568.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bryden J. S., Jennett B. Neurosurgical resources and transfer policies for head injuries. Br Med J (Clin Res Ed) 1983 Jun 4;286(6380):1791–1793. doi: 10.1136/bmj.286.6380.1791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cleland Contribution to the Study of Spina Bifida, Encephalocele, and Anencephalus. J Anat Physiol. 1883 Apr;17(Pt 3):257–292. [PMC free article] [PubMed] [Google Scholar]
  5. Gentleman D., Dearden M., Midgley S., Maclean D. Guidelines for resuscitation and transfer of patients with serious head injury. BMJ. 1993 Aug 28;307(6903):547–552. doi: 10.1136/bmj.307.6903.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gentleman D., Jennett B. Hazards of inter-hospital transfer of comatose head-injured patients. Lancet. 1981 Oct 17;2(8251):853–854. doi: 10.1016/s0140-6736(81)91115-6. [DOI] [PubMed] [Google Scholar]
  7. Gentleman D. Preventing secondary brain damage after head injury: a multidisciplinary challenge. Injury. 1990 Sep;21(5):305–308. doi: 10.1016/0020-1383(90)90047-x. [DOI] [PubMed] [Google Scholar]
  8. Jeffreys R. V., Jones J. J. Avoidable factors contributing to the death of head injury patients in general hospitals in Mersey Region. Lancet. 1981 Aug 29;2(8244):459–461. doi: 10.1016/s0140-6736(81)90786-8. [DOI] [PubMed] [Google Scholar]
  9. Jennett B., MacMillan R. Epidemiology of head injury. Br Med J (Clin Res Ed) 1981 Jan 10;282(6258):101–104. doi: 10.1136/bmj.282.6258.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kirkpatrick P. J., Czosnyka M., Pickard J. D. Multimodal monitoring in neurointensive care. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):131–139. doi: 10.1136/jnnp.60.2.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kirkpatrick P. J. On guidelines for the management of the severe head injury. J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):109–111. doi: 10.1136/jnnp.62.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Koehler P. J. Chiari's description of cerebellar ectopy (1891). With a summary of Cleland's and Arnold's contributions and some early observations on neural-tube defects. J Neurosurg. 1991 Nov;75(5):823–826. doi: 10.3171/jns.1991.75.5.0823. [DOI] [PubMed] [Google Scholar]
  13. Lambert S. M., Willett K. Transfer of multiply-injured patients for neurosurgical opinion: a study of the adequacy of assessment and resuscitation. Injury. 1993 May;24(5):333–336. doi: 10.1016/0020-1383(93)90058-e. [DOI] [PubMed] [Google Scholar]
  14. Maas A. I., Dearden M., Teasdale G. M., Braakman R., Cohadon F., Iannotti F., Karimi A., Lapierre F., Murray G., Ohman J. EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 1997;139(4):286–294. doi: 10.1007/BF01808823. [DOI] [PubMed] [Google Scholar]
  15. Marsh H., Maurice-Williams R. S., Hatfield R. Closed head injuries: where does delay occur in the process of transfer to neurosurgical care? Br J Neurosurg. 1989;3(1):13–19. doi: 10.3109/02688698909001021. [DOI] [PubMed] [Google Scholar]
  16. Mendelow A. D., Karmi M. Z., Paul K. S., Fuller G. A., Gillingham F. J. Extradural haematoma: effect of delayed treatment. Br Med J. 1979 May 12;1(6173):1240–1242. doi: 10.1136/bmj.1.6173.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Miller J. D. Head injury. J Neurol Neurosurg Psychiatry. 1993 May;56(5):440–447. doi: 10.1136/jnnp.56.5.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pickard J. D., Czosnyka M. Management of raised intracranial pressure. J Neurol Neurosurg Psychiatry. 1993 Aug;56(8):845–858. doi: 10.1136/jnnp.56.8.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Teasdale G., Galbraith S., Murray L., Ward P., Gentleman D., McKean M. Management of traumatic intracranial haematoma. Br Med J (Clin Res Ed) 1982 Dec 11;285(6356):1695–1697. doi: 10.1136/bmj.285.6356.1695. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Vyvyan H. A., Kee S., Bristow A. A survey of secondary transfers of head injured patients in the south of England. Anaesthesia. 1991 Sep;46(9):728–731. doi: 10.1111/j.1365-2044.1991.tb09766.x. [DOI] [PubMed] [Google Scholar]
  21. Wilkins R. H., Brady I. A. The Arnold-Chiari malformations. Arch Neurol. 1971 Oct;25(4):376–379. doi: 10.1001/archneur.1971.00490040102013. [DOI] [PubMed] [Google Scholar]

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