Analysis of Prehospital Transport of Head-Injured Patients after Consolidation of Neurosurgery Resources

OBJECTIVES: Consolidation of neurosurgical (NS) services resulted in emergency medical services guidelines mandating transport of head-injured patients to the NS center if the Glasgow Coma Scale score is < 14 and prehospital index is > 3. This study determined what paramedic, system, or patient factors were associated with secondary head-injury transfer. METHODS: This study was a retrospective chart review from January 1996 to November 1998. RESULTS: Ninety-one patient charts were reviewed. The median transport delay to the NS site was 4 hours 22 minutes. After transfer, 79 (96%) patients were admitted, 25 (30%) underwent craniotomy, and 18 (22%) died. The final diagnosis in 35 (43%) cases was subdural hematoma. Triage guidelines were violated in five patients (6%) and the NS center was on diversion in three (4%) cases. Most delays were related to patient presentations; 17 (21%) patients had no history of head trauma. CONCLUSION: Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.