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Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality
  1. T Lawrence1,
  2. A Helmy2,3,
  3. O Bouamra1,
  4. M Woodford1,
  5. F Lecky4,
  6. P J Hutchinson2,3
  1. 1Trauma Audit and Research Network, Manchester Medical Academic Health Sciences Centre, Institute of Population Health, University of Manchester, Salford Royal Hospital, Salford, UK
  2. 2Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
  3. 3Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
  4. 4Centre for Urgent and Emergency Care Research (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  1. Correspondence to Dr A Helmy; adelhelmy{at}


Objectives To provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units.

Design The Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015.

Setting Data were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14n) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed.

Results We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot.

Conclusions We provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • TL and AH are joint first authors.

  • Contributors FL and PJH conceived of the study and have provided detailed review of the results. AH and TL have written the manuscript. TL, OB and MW have carried out the statistical analysis.

  • Funding AH is supported by the University of Cambridge, UK and Medical Research Council/Royal College of Surgeons of England Clinical Research Training Fellowship (grant number G0802251). PJH is supported by National Institute for Health Research Professorship, Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship and the National Institute for Health Research Biomedical Research Centre, Cambridge.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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