Initial assessment and outcome of head injured patients transferred to a regional neurosurgical service: what do we miss?

OBJECTIVE To assess the level of missed extracranial injuries in patients transferred to a regional neurosurgical service for ongoing head injury management. METHODS A three year prospective study conducted under the auspices of the Scottish Trauma Audit Group. All patients were followed during their hospital stay by independent audit staff, their injuries being recorded and scored using established criteria. RESULTS 115 head trauma patients were transferred during the study period. 15 patients died (13% mortality). Eight of a total of 87 separate, scorable extracranial injuries were missed (error rate 9%), none of which was serious. There were no missed injuries in patients who died. 77% of patients were managed by an accident and emergency doctor of at least registrar grade. CONCLUSIONS In contrast to other published series, this study has shown a low rate of missed extracranial injuries in a group of patients whose initial assessment is notoriously difficult. Early involvement by an experienced accident and emergency doctor may play an important part in the overall management of such patients.