Warning over treatment of head trauma victims

Two in five patients who suffered severe head injuries in 2014 and 2015 were not treated at neurological centres, despite clear evidence of much better outcomes for patients when this is the case.

The finding is contained in the first Major Trauma Audit Report 2014-2015 which focuses on the most severely injured patients in the Irish healthcare system.

Writing in the foreword to the report, Dr Conor Deasy, chair of the audit’s governance committee and Dr Colm Henry, HSE group lead for acute hospitals, warn of “high numbers of trauma patients going to hospitals that cannot provide necessary and definitive care”.

The Irish Association of Emergency Medicine (IAEM) echoed this concern in their response to the report saying it “confirms that 40% of severe head injuries are not treated at neurosurgical centres in Ireland, despite clear evidence of much better outcomes for such patients.... in England this figure is 15%”.

Among the report’s other main findings were:

  • More than 50% of major trauma patients incurred their injuries following ‘low falls’ (less than 2m), followed by road traffic collisions at 21%. Of 2,967 severely injured patients in 2015, 1536 were injured as a result of low falls;
  • While the greatest number of deaths were due to low falls, the highest death rate was associated with major trauma patients who had suffered blows (46% in 2015) and asphyxia/drowning (31%);
  • 23% of major trauma patients had severe head injuries;
  • 30% of patients had to be transferred to another hospital for ongoing care as their care needs could not be provided by the initial receiving hospital;
  • Just 11% of patients were seen by a consultant in the emergency department within 30 minutes of arrival. Just 9% were received by a trauma team.

The report points out the NHS clinical advisory group (2010) recommended that trauma teams in major trauma centres should be led by a consultant and by an experienced registrar at trauma units. However, the report notes that “trauma teams are not widely utilised in the reception of major trauma patients...yet have been shown to be associated with better process metrics and outcomes”.

The report’s authors say it is “timely that the Department of Health Strategic Advisory Group on development of trauma networks has been established to advise on how such a trauma system might be developed in Ireland”.

It makes a series of recommendations including that clear national guidance is needed to support hospitals in developing trauma teams; that the audit should be used to quality assure and improve major trauma care in Ireland; that health services need to take account of the high incidence of older patients sustaining major trauma and that patients have equity of access to expertise to maximise outcomes.


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