by Belinda J. Gabbe, Ronan A. Lyons, Fiona E. Lecky, Omar Bouamra, Maralyn Woodford, Timothy J. Coats, Peter A. Cameron
Background Traumatic brain injury (TBI) remains a leading cause of death and disability.
The National Institute for Health and Clinical Excellence (NICE) guidelines
recommend transfer of severe TBI cases to neurosurgical centres,
irrespective of the need for neurosurgery. This observational study
investigated the risk-adjusted mortality of isolated TBI admissions in
England/Wales, and Victoria, Australia, and the impact of neurosurgical
centre management on outcomes.
Methods Isolated TBI admissions (>15 years, July 2005–June 2006) were
extracted from the hospital discharge datasets for both jurisdictions.
Severe isolated TBI (AIS severity >3) admissions were provided by the
Trauma Audit and Research Network (TARN) and Victorian State Trauma Registry
(VSTR) for England/Wales, and Victoria, respectively. Multivariable logistic
regression was used to compare risk-adjusted mortality between
jurisdictions.
Findings Mortality was 12% (749/6256) in England/Wales and 9% (91/1048)
in Victoria for isolated TBI admissions. Adjusted odds of death in
England/Wales were higher compared to Victoria overall (OR 2.0, 95%
CI: 1.6, 2.5), and for cases <65 years (OR 2.36, 95% CI: 1.51,
3.69). For severe TBI, mortality was 23% (133/575) for TARN and
20% (68/346) for VSTR, with 72% of TARN and 86% of VSTR
cases managed at a neurosurgical centre. The adjusted mortality odds for
severe TBI cases in TARN were higher compared to the VSTR (OR 1.45,
95% CI: 0.96, 2.19), but particularly for cases <65 years (OR
2.04, 95% CI: 1.07, 3.90). Neurosurgical centre management modified
the effect overall (OR 1.12, 95% CI: 0.73, 1.74) and for cases <65
years (OR 1.53, 95% CI: 0.77, 3.03).
Conclusion The risk-adjusted odds of mortality for all isolated TBI admissions, and
severe TBI cases, were higher in England/Wales when compared to Victoria.
The lower percentage of cases managed at neurosurgical centres in England
and Wales was an explanatory factor, supporting the changes made to the NICE
guidelines.
