A survey by the Royal College of Surgeons found one in five accident and emergency departments lacks a brain scanner, which is essential to diagnose head injuries and determine the need for surgery.
Hospitals should be banned from receiving head-injury patients unless these facilities are available 24 hours a day, the report says. Half of those injured are children and the main causes are falls and assaults. One in six head injuries is caused by a road accident but these tend to be more serious. Overall, the death rate is 1 per cent but one in five among people aged 5 to 35.
For the survivors the prognosis is not good. Almost two- thirds of those with a moderate head injury, requiring a stay of more than 48 hours in hospital, and 85 per cent who suffer a severe head injury, requiring intensive care or surgery, remain disabled a year later.
Even among those with minor head injuries, over half have memory problems and four out of five have persistent headaches three months later. There is increasing evidence that 30 per cent of those with minor injuries discharged from hospital without symptoms show signs of illness three months later.
The survey was based on 243 accident and emergency departments contacted in December 1997 and January 1998. Charles Galasko, chairman of the college's working party on head injuries, said: "Many patients who survive are left with behavioural, emotional and physical damage resulting in marital breakdown, loss of employment and significant cost to the community. The resources available for treating them in terms of manpower, facilities and beds are inadequate." Seven out of ten accident and emergency departments had no access to a brain surgeon and more than one in ten were more than 50 miles from the nearest neurosurgical unit, which meant a hazardous journey by ambulance. Fewer than half of 300 general surgeons responsible for looking after head-injury patients had been trained to manage them.
Barry Jackson, president of the Royal College of Surgeons, said patients often had to wait in a hospital bed or travel long distances for specialist treatment, and delays reduced their chances of a full recovery. "The recommendations in this report ... are badly needed."Reuse content