Management of Major Head Injuries at a Regional New Zealand Hospital
McIntosh ND, Hawkes Bay Fallen Soldiers' Memorial Hospital, Hawkes Bay District Health Board Lo A, Hawkes Bay Fallen Soldiers' Memorial Hospital, Hawkes Bay District Health Board
Introduction: Head injuries represent a significant burden of acute trauma admissions. They require prompt diagnosis and treatment however, regional centres do not always have onsite radiology or neurosurgery services available. The burden of major head injuries and their management has not been reviewed in regional New Zealand hospitals.
Aim: To review the burden and management of traumatic head injuries in a regional hospital.
Hypothesis: Major head injuries are complex injuries to manage in regional hospitals. There is delay with diagnosis and treatment due to the lack of full-time radiology and neurosurgical services.
Methods: A review of a prospectively collected database was undertaken. All patients presenting with major trauma (ISS≥13) and an identified head injury to Hawkes Bay Fallen Soldiers’ Memorial Hospital from 01 Jan 2020 to 31 Dec 2020 were included. Baseline demographics, mechanism, injury and management details were collected.
Results: Thirty patients were hospitalised with major head injuries with a median age of 53.5 years (range 6 months to 93 years). There were equal gender and near-equal ethnic distributions (50% NZE, 43% Māori) with 53% of injuries were related to falling. Time from arrival to CT was slow, particularly after-hours (107 minutes during normal hours vs 127 minutes after-hours). Local management and transfer were equal. The median admission length was 8.5 days. Five patients (17%) died during their admission while three patients (10%) were readmitted during a 30 day period the total post injury complication rate to 27%.
Conclusion: Major head injury is a significant burden for regional hospitals, particularly among Māori. There is a predisposition to falls among elderly patients. While half of cases can be managed locally, the lack of onsite radiology or neurosurgical services leads to significant delays in diagnosis and treatment. The high morbidity seen in this group highlights a need for improvement in service provision.