Treatment of extradural haemorrhage in Queensland: interhospital transfer, preoperative delay and clinical outcome.

Objectives: To measure preoperative delays and clinical outcomes of patients with extradural haemorrhage, comparing patients presenting to hospitals with no neurosurgical facilities, with those presenting directly to neurosurgical centres.

Methods: Retrospective case study with data collected from 10 centres. Patients were identified with a search of the Queensland Trauma Registry database. A total of 315 charts were reviewed, of patients presenting or referred to Queensland's public hospitals between 2002 and 2004 inclusive.

Results: A total of 261 patients were included in the study. One hundred and fifty-nine patients presented to hospitals with no neurosurgical facilities; 102 presented directly to neurosurgical centres. Forty-six patients underwent interhospital transfer (IHT) before decompressive craniotomy; their median time interval from presentation to operation was 8 h 5 min. This delay was significantly greater than that for 25 patients admitted directly to neurosurgical centres (median 4 h 19 min; P = 0.0006). After excluding patients who had sustained hypoxic or hypotensive insults or serious extracranial injuries, all deaths (five) occurred in patients undergoing IHT before craniotomy.

Conclusions: IHT of patients with extradural haemorrhage causes significant preoperative delay.