Objectives To identify factors that influence the decision to transfer patients with traumatic brain injury (TBI) to a neurosurgical centre.
Design Retrospective data collected as part of TrIBAL study.
Subjects All patients with TBI referred to our neurosurgery unit from regional acute hospitals over a 4 month period.
Methods Our primary outcome was transfer to a neurosurgical centre. We identified the following factors that may predict decision to transfer: patient demographics, transfer distance, anticoagulation therapy and severity of TBI (initial GCS and Marshall score). A multivariable logistic regression analysis was performed.
Results A total of 347 patients were referred from regional hospitals with TBI and of these, 53 (15%) were transferred. The mean age of patients referred was 69.6 years, 62.5% were men and 43% on antiplatelets or anticoagulated. Similar number of patients were referred from hospitals within 30 miles (54%) and those more than 30miles away (46%). Eighty-four percent of patients had mild TBI (GCS 13–15) on initial assessment and 67% had a Marshall CT score of 2. After regression analysis, younger age, male gender and higher Marshall score predicted transfer to our neurosurgical centre (p<0.05).
Conclusions Many patients with TBI have relatively ‘minor’ injuries and remain at their local hospital. In our cohort higher Marshall score, younger age and male gender predicted transfer to a neurosurgicial centre. Transfer distance, anticoagulation therapy and initial GCS did not influence decision to transfer.
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