Clinical and neuroimaging features of severely brain-injured patients treated in a neurosurgical unit compared with patients treated in peripheral non-neurosurgical hospitals.

Most European TBI patients are managed in peripheral hospitals without benefit of guidelines for transfer of such patients to neurosurgical units as needed. This report compares clinical features and outcomes in two series of severe TBI patients: those admitted to a neurosurgical centre or to a general hospital, all in the Piedmont Region of Italy. Of 630 patients with a GCS of 3-8, 351 were admitted to a centralized neurosurgical unit, and 279 were admitted and treated at a peripheral hospital. All patients had a CT scan read by a neurosurgeon on duty and were classified using the Marshall criteria as having a diffuse injury or non-surgical mass lesions. Outcomes were assessed between 6 months and 6 years using either the GOS Extended or the GOS. Independent variables were age, sex, GCS score and Marshall classification. All the examined factors were significantly different between the two groups (p<0.001). For patients admitted to the neurosurgical centre, age, Marshall classification of the CT and GCS were predictors of a favourable outcome, while for patients treated in general hospitals, Marshall classification of the CT, gender and age were predictors of a favourable outcome. Patients admitted to neurosurgical centres are different from those treated in general hospitals not having these specialized facilities and personnel. The absence of guidelines for the transfer of these patients for more advanced care are lacking and should be the focus of new studies on patient referral.