Unnecessary admissions of head-injured patients at the University Hospital of the West Indies

The prospectively collected data in the Jamaica National Trauma Registry operated by the Section of Surgery identified 88 patients who were admitted with head injury to the University Hospital of the West Indies over a one-year period There were 67 males (76.1 %), the mean (SD) age of the entire group being 35.02 ( +/- 18.45) years. Intentional injuries occurred in 47.2%. The Injury Severity Score was greater than 15 in 19.3%, severe head injuries occurred in 19% and overall mortality was 16%. Care in the Intensive Care Unit (ICU) was extended to only half of those with the severe injuries. The Scottish Intercollegiate Guidelines Network (SIGN) method was used to assess the appropriateness of admission to hospital. Sixteen (18%) of the 88 patients were inappropriately admitted according to SIGN guidelines. Increased efficiency may result from standardization of admission criteria for head-injured patients and consistent implementation of the SIGN guidelines for admission without increased risk to patients. This may be expected to minimize unnecessary admissions and result in considerable cost savings.