Six-year review of traumatic brain injury in a regional trauma unit: demographics, contributing factors and service provision in Ireland

Background: Traumatic brain injury (TBI) represents a significant burden of care for acute surgical services, particularly in the absence of on-site neurosurgical cover or sufficient post-acute rehabilitation facilities. We examine factors contributing to TBI, prolonged lengths of stay (LoS) and implications for hospital resources. Long-term outcomes are assessed.Methods: This is a retrospective cohort study of patients admitted to a regional trauma unit with TBI from 2008 to 2013. Patients with LoS48h were assessed. Demographic, clinical and longitudinal mortality data were collected using electronic clinical and radiological systems and chart review.Results: A total of 690 patients presented with TBI from 2008 to 2013; 213 patients with LoS48h were assessed. One hundred and thirty (61%) were male. Mean age was 56years (SD 24). Mechanical fall was the most frequent injury mechanism (n=120 213, 56%). Twenty-five per cent were associated with alcohol consumption; these were more likely to be male, involved in an Road Traffic Accident (RTA) or assault and necessitate transfer to a neurosurgical unit (p0.001, p=0.029, p0.001, p=0.05). A total of 112 patients(53%) had a prolonged LoS (2weeks). Mean LoS was 20days (+ - SD 35), increasing to 39days for patients requiring neurosurgical intervention. The 12-month all-cause mortality rate was 12%.Conclusions: TBIs result in significant utilisation of acute inpatient bed days. Improved rehabilitation services and strategies to reduce acute hospital LoS are warranted.