Extrait

Background and study aims Severe head injury is the most common cause of death and disability in people aged under 44 in the UK. Currently patients with severe head injury are transported by ambulance to the nearest hospital, regardless of whether that hospital has specialist brain surgeons (neurosurgeons). They are assessed by emergency doctors who then decide whether they need to be transported on to a specialist centre. This approach has the advantage of getting patients to a hospital quickly so they can be treated for any immediately life-threatening injuries, but has the disadvantage of increasing the time before they receive specialist care. An alternative approach is for patients with severe head injuries and no other obvious life-threatening injuries to bypass the nearest hospital and go straight to a specialist neurosurgical centre. This has the advantage of getting the patient to specialist care quicker, but may delay treatment of other serious injuries. For example, a patient with serious internal bleeding that is not recognised by the paramedics could have treatment of this bleeding delayed if they bypassed the nearest hospital and were taken to a specialist centre. This issue has recently been debated in the national media and patients with serious head injuries have been used as an example where travelling a longer distance to a specialist hospital could be in the patients' interest. However, the National Institute for Health and Clinical Excellence (NICE) recently decided that the current evidence was inconclusive, and stated that this is an important issue in need of further study. We plan to answer this question by undertaking a feasibility study for a larger study, in which patients will be randomly allocated to either be transferred to the nearest hospital or transferred directly to a specialist neurosurgical centre. Who can participate? Patients aged over 15 with a severe head injury What does the study involve? Participating ambulance stations are randomly allocated to either transport all head injury patients straight to a specialist neurosurgical centre, or to the nearest hospital (usual care). We assess whether ambulance service crews comply with the random allocation and recruit the right patients. We also measure patients' survival and health over the following six months to detect if either approach leads to better outcomes for patients. We also calculate whether bypassing the nearest hospital is cost effective. What are the possible benefits and risks of participating? Not provided at time of registration Where is the study run from? Salford Royal Hospital (UK) When is the study starting and how long is it expected to run for? July 2011 to June 2012 Who is funding the study? NIHR Health Technology Assessment Programme - HTA (UK) Who is the main contact? Dr Fiona Lecky

Critère d'inclusion

• traumatic brain injury

Liens

• isrctn
• ictrp