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The effect of specialist neurosciences care on outcome in adult severe head injury: a cohort study

Lookup NU author(s): Professor Alexander Mendelow

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Abstract

Background: Head injury is the leading cause of death in trauma. UK national guidelines have recommended that all patients with severe head injury (SHI) should be treated in neuroscience centers. The aim of this study was to investigate the effect of specialist neuroscience care on mortality after SHI.Methods: We conducted a cohort study using prospectively recorded data from the largest European trauma registry, for adult patients presenting with blunt trauma between 2003 and 2009. Mortality and unadjusted odds of death were compared for patients with SHI treated in neuroscience units (NSU) versus nonspecialist centers. To control for confounding, odds of death associated with non-NSU care were calculated using propensity score-adjusted multivariate logistic regression (explanatory covariates: age, Glasgow Coma Score, Injury Severity Score, treatment center). Sensitivity analyses were performed to study possible bias arising from selective enrollment, from loss to follow-up, and from hidden confounders.Results: 5411 patients were identified with SHI between 2003 and 2009, with 1485 (27.4%) receiving treatment entirely in non-NSU centers. SHI management in a non-NSU was associated with a 11% increase in crude mortality (P<0.001) and 1.72-fold (95% confidence interval: 1.52-1.96) increase in odds of death. The case mix adjusted odds of death for patients treated in a non-NSU unit with SHI was 1.85 (95% confidence interval: 1.57-2.19). These results were not significantly changed in sensitivity analyses examining selective enrollment or loss to follow-up, and were robust to potential bias from unmeasured confounders.Conclusions: Our data support current national guidelines and suggest that increasing transfer rates to NSUs represents an important strategy in improving outcomes in patients with SHI.


Publication metadata

Author(s): Fuller G, Bouamra O, Woodford M, Jenks T, Patel H, Coats TJ, Oakley P, Mendelow AD, Pigott T, Hutchinson PJ, Lecky F

Publication type: Article

Journal: Journal of Neurosurgical Anesthesiology

Year: 2011

Volume: 23

Issue: 3

Pages: 198-205

Print publication date: 01/07/2011

ISSN (print): 0898-4921

ISSN (electronic): 1537-1921

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1097/ANA.0b013e3182161816

DOI: 10.1097/ANA.0b013e3182161816


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