Available online 13 September 2022

During the study six-year study period, 30,891 patients sustained major trauma meeting inclusion criteria for MTA, of which 7,393 (23.9%) patients met the inclusion criteria for Traumatic brain injury (TBI), 1,025(13.9%) were classified as severe.

Our study highlights the issue of access to expert neurosurgical and neurocritical care in Ireland; 55.7% (571) of patients with severe TBI and 54.7% (301) of isolated severe TBI patients were treated in a neurosurgical centre.

Severe TBI patients are less likely to be transferred to a neurosurgical centre if they are older (Adjusted OR 0.96, 95% CI 0.95-0.973) or have another injury requiring surgery (Adjusted OR 0.31, 95% CI 0.18-0.53).

The overall 30-day mortality rate for the total all patients with TBI was 11.6% (855) and 42.4% (435) in severe TBI patients.

Patients were more likely to die if they were older (OR 1.04, 95% CI 1.03-1.05) or had a higher ISS score (OR 1.07, 95% CI 1.05-1.08).

Of severe TBI patients admitted to hospital, 21.3% (218) were discharged home and 4.6%[47] were discharged to a rehabilitation unit.

: Traumatic brain injury (TBI) is the most significant cause of death and disability resulting from major trauma. The aim of this study is to describe the demographics of TBI patients, the current pathways of care and outcomes in the Republic of Ireland from 2014-2019.

: We performed a retrospective review of all TBI patients meeting inclusion criteria in Ireland's Major Trauma Audit (MTA) from 2014-2019. Severe TBI was defined as an abbreviated injury scale (AIS) ≥3 and GCS ≤8.

: During the study period, 30,891 patients sustained major trauma meeting inclusion criteria for MTA, of which 7,393 (23.9%) patients met the inclusion criteria for TBI; 1,025 (13.9%) were classified as severe. The median age was 60.6 years (IQR 36.9-78.0), 54.3 years (32.8-73.4) for males and 71.7 years (50.0-83.0) for females (p<0.001). Of patients with severe TBI, 185 (18.0%) were brought direct to a neurosurgical centre, 389 (37.9%) were transferred to a neurosurgical centre and 321 (31.3%) had a neurosurgical intervention performed. In patients sustaining severe TBI, older patients (Adjusted OR, 0.96,95% CI 0.95-0.97) and patients requiring another surgery (OR 0.31, 95%CI 0.18-0.53) were less likely to be secondarily transferred to a neurosurgical centre. There were 47 (4.6%) patients with severe TBI discharged to rehabilitation. The 30-day mortality in Ireland was 11.6% in all TBI patients and 45.5% in severe TBI patients. Older patients and patients with higher ISS had a higher chance of death. Male patients, patients treated in neurosurgical centre, patients who had neurosurgery or non-neurosurgical surgery had a higher chance of survival.

: This population-based study bench marks the ‘as is’ for patients with TBI in Ireland. We found that presently in Ireland, the mortality rate from severe TBI appears to be higher than that reported in international literature, and only a minority of severe TBI patients are brought directly from the incident to a neurosurgical centre. The new major trauma system should focus on providing effective and efficient access to neurosurgical, neuro-critical and neuro-rehabilitative care for patients who sustain TBI.

Trauma

Brain injury

neurosurgery

trauma systems

© 2022 The Author(s). Published by Elsevier Ltd.