An Audit of the Quality of Care of Traumatic Brain Injury at a Busy Regional Hospital in South Africa (Trauma) (Report‪)‬

Traumatic brain injury (TBI) is a common clinical problem with significant long-term morbidity. Minimising this morbidity requires aggressive attempts to prevent secondary brain injury. The major early causes of secondary brain injury are hypoxia, hypovolaemia, hypoglycaemia and raised intracranial pressure (ICP). The first three conditions may be prevented by relatively simple clinical interventions that can be performed at almost any level of health facility. However, a subset of patients will have an acute space-occupying lesion contributing to raised ICP, which exacerbates the ischaemic insult to the brain; reducing ICP is more difficult and may require more complex interventions. These range from simply placing the patient in the reverse Trendelenburg position to facilitate venous drainage of the cranium to administering mannitol and hypertonic saline, progressive hypocapnia, pharmacological manipulation using intravenous barbiturates, and possibly neuromuscular blockade, ventricular drainage and decompressive craniectomy. These interventions can only be undertaken at advanced facilities where specialist neurosurgical and intensive care is available. Limitations on resources mean that it is unlikely that all head-injured patients will have the benefit of care in a dedicated neurosurgical unit. The vast majority will continue to be managed by non-neurosurgeons, be they referring staff, accident and emergency staff, paramedics, trauma surgeons or intensivists. This audit attempted to quantify the volume of TBI in a busy regional hospital with geographically remote specialised neurosurgical services and to assess the quality of the care rendered at the regional hospital to patients with TBI. Methodology