Audit of Traumatic Brain Injury Management at the National Major Trauma Centre

Abstract Background Ireland’s national trauma strategy1 advocates for coordinated, specialist-led trauma care within Major Trauma Centres (MTCs) to improve patient outcomes. This audit evaluated the management of traumatic brain injuries (TBIs) at the newly designated National MTC during its first 14 months, benchmarking against national trauma guidelines. Methods A retrospective review of TBI admissions from July 2023 to September 2024 was performed. Data collected included demographics, injury characteristics, care pathways, and outcomes such as length of stay and 30-day mortality. Compliance with national standards for specialist ward admission and neurosurgical referral was assessed. Results Of 203 TBI cases, 147 (72.4%) were male and 107 (52.7%) were aged ≥65 years old. TBIs included 39.0% subdural haematomas, 18.2% subarachnoid haemorrhages, 14.3% intraparenchymal haemorrhages and 22 (10.8%) mixed haemorrhages. Falls from 2 metres accounted for 56% of presentations. Intensive care was required in 29 (14.3%) cases, while 123 (60.6%) were managed on trauma wards. 13.8% (28) required transfer to neurosurgical centre. GCS changes were the only significant predictor of transfer (p = 0.017). Among older patients, 21.5% had dementia, 16.8% were nursing home residents and frailty was common (mean clinical frailty score 4.88). The 30-day mortality was higher (7.4%) compared to younger patients (2%), along with the median length of stay, which was 9 days and 5 days, respectively. Conclusion This audit highlights the diverse patient cohort in trauma care. It highlights adherence to guidelines, with neurosurgical transfer guided by clinical deterioration, not age or other factors. The guidelines advocates for specialist beds; however, due to limited availability, some patients were managed outside dedicated trauma wards. A TBI unit has opened to meet this demand. Cycle two will examine the effects of these changes on 30-mortality and length of stay. Reference 1. Trauma Steering Group. A trauma system for Ireland: report of the trauma steering group. 2018.