CRITICAL CARE TRIALS GROUP

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CRITICAL CARE TRIALS GROUP

• BRAIN INJURY AUDIT

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Introduction

• 1200 intensive care admissions
• 10 week period in 2006
• 14 centres in the Island of Ireland
• 129 severe brain injury admissions
• Etiology
• Source of admission
• Outcome
• Death
• Transfer
• Discharged
• Organ donation

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Etiology of Brain Injury

• Total Number of admissions 129.
• gt 1/2 Traumatic
• 1/4 SAH
• 1/5 Stroke

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Outcome

• 1/3 of brain Injured patients died. (n43)
• Brain Dead (n27)
• Brain Death not certified (n16)

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Organ Donation.

• 9 No request
• 12 Consented
• 6 Refused

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Neurosurgical Centres / Population

• Republic of Ireland (pop. 4 235 000)
• Beaumont - 10 designated
  neurosurgical beds
• Cork University - No designated
  neurosurgical beds
• - 8 ICU beds
• Northern Ireland (pop. 1 685 000)
• Royal Victoria - No designated Neurosurgical
  beds
• - 17 ICU beds

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Treatment Centre

• 1/3 cared for in non-neurosurgical centres.
• 2/3 cared for in a neurosurgical centre.

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Treatment Centre

• 1/5 of Traumatic Brain Injuries treated in
  Non-Neurosurgical Centre.
• 1/3 of SAH treated in Non-Neurosurgical Centre.

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Neurosurgical Centre

• 2/3 Direct admissions to neurosurgical centre.
• 1/3 Secondary transfers to neurosurgical
  centre.

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Mortality by Aetiology (Overall)

• 1/3 Traumatic
• 1/3 SAH
• 1/4 stroke

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Mortality by Aetiology ( Non-Neurosurgical Centre)

• 1/3 SAH
• 1/3 Stroke
• 1/5 Trauma
• Selective transfer of trauma patients to
  specialist centres?

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Mortality by Aetiology (Neurosurgical Centre)

• 1/2 Trauma
• 1/3 SAH
• 1/5 stroke
• High trauma workload

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Neurosurgical Centre

• Slight increase in mortality in the transferred
  group.

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Outcome by centre (Overall)

• ½ Patients in Non-Neurosurgical Centre died.
• 1/3 Patients in Neurosurgical Centre died.
• Better care in specialist centre?
• Selective transfer of most viable patients?

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Traumatic Brain Injury outcome by centre

• 1/4 TBI in Non-Neurosurgical centre died. (n3)
• 1/5 TBI in Neurosurgical centre died. (n11)

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SAH outcome by centre

• 3/4 SAH in Non-Neurosurgical centre died. (n6)
• 1/2 SAH in Neurosurgical centre died. (n8)

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Neurosurgical centres admission sources
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Conclusions

• Serious Brain Injury is common and has high
  mortality.
• Trauma and SAH most common causes.
• Significant proportion cared for in
  Non-Neurosurgical Centres.
• Neurosurgical centres have high trauma work load.
• Need to explore organ donor rates.

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Guidelines

• ICP monitoring
• Cerebral perfusion threshold
• Brain oxygen monitoring
• Barbiturate therapy
• Hyperventilation
• Decompressive craniotomy
• Guidelines for the management of severe traumatic
  brain injury. Journal of Neurotrauma. Vol 24
  Supplement 1. 2007.Brain Trauma Foundation.

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Summary

• Brief snapshot
• Small numbers / Not all units included
• Need for further larger studies

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• Thank you