Time of hospital presentation may be important

doi:10.1136/bmj.39507.481840.80

BMJ 2008;336:522 (8 March), doi:10.1136/bmj.39507.481840.80

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Traumatic brain injury

Time of hospital presentation may be important

The first 150 words of the full text of this article appear below.

The MRC CRASH trial collaborators’ simple prognostic modelcan be used to predict outcomes in patients with traumatic braininjury.¹ Although the model considered time from injury to randomisation,the time at which the patient presented to hospital was notconsidered as a potential independent prognostic variable. Thisis important because provision of key aspects of hospital traumaservices such as staffing, access to operating theatres, andinterventional radiology is reduced after normal working hours.

In the UK, a recent study examined the process of care for 795severely injured patients—493 with a head injury.² Mostpresented to the accident and emergency department out of hours(18.00-07.59 hours or weekends). Initial management of the patientwas inappropriate in 23.5% of cases when a senior house officerwas the team leader or first reviewer compared with 3.1% whena consultant performed this role. Consultants were involvedin 39.6% of cases during . . . [Full text of this article]

Paul Frost, consultant in intensive care medicine, Matt P Wise, consultant in intensive care medicine

¹ Critical Care Directorate, University Hospital of Wales, Cardiff CF14 4XW

Paul.Frost@CardiffandVale.wales.nhs.uk

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