Management and outcomes of patients with brain trauma in a tertiary referral trauma hospital without neurosurgeons on site.

Waikato Hospital is a tertiary hospital of over 700 beds receiving large numbers of trauma patients, but has no neurosurgeon closer than 130 kilometres. Over the 10 years ending July 1997, 831 cases of brain trauma were admitted to the Intensive Care Unit. Of these, 191 died before leaving hospital (overall mortality 23%). Of the 547 who had a Glasgow Coma Score (GCS) < or = 8, 173 died (mortality 32%). Of the children who were < 15 years of age and had a GCS < or = 8, there was a 23% mortality. These mortality rates are acceptable when compared with other reports (average 37%, over 12 adult series). Using brain AIS scores, our mortality figures also compared favorably with those in the literature, and suggest that the quality of brain trauma care is adequate in this non-neurosurgical centre with intensive care, backed by CT scanning and general surgeons able to do urgent burr holes. Six percent of the brain trauma patients (approximately five per year), required interhospital transfer for definitive neurosurgical care.