Skip to main content

Transfer delays in patients referred for neurosurgical intervention with traumatic brain injury


National guidance for patients presenting to the emergency department (ED) with a traumatic head injury advises that head computed tomography (CT) should be performed and reported within 1 hour [1]. The operative intervention or injury to knife time should be within 4 hours [2]. With more than 50% of patients requiring neurosurgical intervention in the UK taken to hospitals without onsite neurosurgical services [3], secondary transfer is necessary prior to definitive intervention. Are we achieving timely transfers in rural England?


The Royal Cornwall Hospital is a district general hospital serving a population of 300,000. The regional neurosurgical unit is 100 km away. All patients undergoing transfer to the neurosurgical unit during 2009 were identified. A notes review was undertaken of all these patients transferred to the care of neurosurgeons. The operative logs were also reviewed. Time lines were created of their care from ambulance call to neurosurgical intervention.


Ten patients in total were transferred for neurosurgical intervention. Two of these patients required two transfers as they were initially seen in satellite minor injury units. No patient had CT within 1 hour of arriving in the ED. The median time was 2 hours 56 minutes. The CT report was available at a median of 3 hours 17 minutes. None of these patients arrived in the tertiary referral centre within 4 hours of their injury. The fastest time to intervention was 8 hours 29 minutes, median 22 hours 59 minutes after injury.


We are not meeting targets for CT head acquisition and transfer for neurosurgical intervention. Prompt transfer of a trauma patient from a rural district general hospital in the UK to a tertiary referral centre for neurosurgical intervention is a multifactorial problem. The introduction of trauma centres and of protocols for direct admission to tertiary centres by paramedics may reduce the delays that our audit has highlighted.


  1. 1.

    Head Injury Triage: Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults, Methods Evidence and Guidance. Commissioned by the National Institute for Health and Clinical Excellence. []

  2. 2.

    Better Care for the Severely Injured. Joint Report. Royal College of Surgeons of England and British Orthopaedic Association. []

  3. 3.

    Trauma: Who Cares?. Report. National Confidential Enquiry into Patient Outcome and Death. []

Download references

Author information



Corresponding author

Correspondence to L Smith.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Smith, L., Jordan, B. & Paddle, J. Transfer delays in patients referred for neurosurgical intervention with traumatic brain injury. Crit Care 16, P475 (2012).

Download citation

  • Published:

  • DOI:


  • Traumatic Brain Injury
  • Tertiary Referral Centre
  • Rural District
  • Compute Tomography Head
  • District General Hospital