BACKGROUND: @entity542 is the leading cause of @entity204 in @entity130 . UK national guidelines have recommended that all @entity1 with severe @entity542 (SHI) should be treated in neuroscience centers. The aim of this study was to investigate the effect of specialist neuroscience care on mortality after SHI. METHODS: We conducted a cohort study using prospectively recorded data from the largest European @entity130 registry, for adult @entity1 presenting with @entity130 between 2003 and 2009. Mortality and unadjusted odds of @entity204 were compared for @entity1 with SHI treated in neuroscience units (NSU) versus nonspecialist centers. To control for confounding, odds of @entity204 associated with non-NSU care were calculated using propensity score-adjusted multivariate logistic regression (explanatory covariates: age, Glasgow @entity772 Score, Injury Severity Score, treatment center). Sensitivity analyses were performed to study possible bias arising from selective enrollment, from loss to follow-up, and from hidden confounders. RESULTS: 5411 @entity1 were identified with SHI between 2003 and 2009, with 1485 (27.4%) receiving treatment entirely in non-NSU centers. SHI management in a non-NSU was associated with a 11% increase in crude mortality (P<0.001) and 1.72-fold (95% confidence interval: 1.52-1.96) increase in odds of @entity204 . The case mix adjusted odds of @entity204 for @entity1 treated in a non-NSU unit with SHI was 1.85 (95% confidence interval: 1.57-2.19). These results were not significantly changed in sensitivity analyses examining selective enrollment or loss to follow-up, and were robust to potential bias from unmeasured confounders. CONCLUSIONS: Our data support current national guidelines and suggest that increasing transfer rates to NSUs represents an important strategy in improving outcomes in @entity1 with SHI.

The effect of specialist neurosciences care on outcome in adult severe XXXX : a cohort study.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity542 :: ('MESH:D006259', 'Disease') :: ['Head injury', 'head injury'] @entity772 :: ('MESH:D003128', 'Disease') :: ['Coma'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity130 :: ('MESH:D014947', 'Disease') :: ['blunt trauma', 'trauma']
@entity542 :: (MESH:D006259,Disease) :: ['head injury']
