Reduction in mortality from severe head injury following introduction of a protocol for intensive care management

Background. To determine the effect of an intensive care managementprotocol on the intensive care unit (ICU) and hospital mortalityof severely head-injured patients, we designed a longitudinalobservational study of all patients admitted with a head injurybetween 1992 and 2000. Methods. A computerized patient database was used to identifyall patients with severe head injury admitted to the ICU atFrenchay Hospital, Bristol, UK: a tertiary referral centre forthe clinical neurosciences. We compared the ICU and hospitalmortality and length of stay in patients before and after implementationof a protocol for their ICU management in 1997. Results. Implementation of the protocol was associated witha significant reduction in ICU mortality from 19.95% to 13.5%(odds ratio 0.47; 95% CI 0.29–0.75), and in hospital mortalityfrom 24.55% to 20.8% (odds ratio 0.48; 95% CI 0.31–0.74).This was achieved despite a significant increase in the medianAPACHE II score (14 vs 18) of patients admitted after implementationof the protocol. The median ICU and hospital length of stayremained constant over the study period. Conclusions. The introduction of an evidence-based protocolto guide the ICU management of patients with severe head injuryhas been associated with a significant reduction in both ICUand hospital mortality.