The changing landscape of traumatic brain injuries at a district general hospital in a trauma network.

Abstract

Background: Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced. We compare outcomes of TBI patients pre- (2008-2012) and post-MTC (2013-2021) network implementation.

Methods: We conducted a retrospective analysis of TBI patients admitted to a 500-bedded DGH, before and after the introduction of a trauma network. We compared the characteristics of patients, including age, mechanism of injury, imaging findings, and length of stay. All statistical analyses were carried out in SPSS v29 (IBM).

Results: Overall, 876 patients (males = 56.1%; median age 67 years) were included. Mean yearly cases pre-MTC was 76 compared to 55 in the post-MTC period. Mean age was significantly higher, and patients had more co-morbidities, in the post-MTC period (p < 0.001). Mean GCS at presentation was not significantly different between the pre- and post-MTC periods (13.7 vs 13.8, respectively). Referrals to the regional neurosurgical centre were significantly higher in the post-MTC period. The overall mortality rate was 33.7%. Increasing age (OR = 1.072), higher comorbidities (OR = 1.243) and intracerebral haematoma (OR = 6.269) were associated with a higher risk of death. The post-MTC period was associated with a lower risk of death (OR = 0.501).

Conclusions: Fewer patients with less severe mechanisms of injury, and a more elderly population are now being managed at our DGH in the post-MTC period. Mortality was similar to published literature but the introduction of the trauma system was associated with lower risk of death. Although fewer TBIs help to optimise service delivery by maintaining orthopaedic bed capacity, the reduced exposure to these patients may lead to lowered expertise in managing these complex cases.