Traumatic brain injury (TBI) is a leading cause of mortality and morbidity, and is a considerable burden to public health globally [1]. The highest mortality rates amongst TBI patients occur in those who suffer from severe TBI, defined as having a Glasgow Coma Score (GCS) of 8 or less, and an abbreviated injury score (AIS) of 3 or more [2]. The National Institute for Health and Care Excellence (NICE) in the UK, recommends transfer of all patients with severe TBI to a neurosurgical unit regardless of the need for neurosurgical intervention [3]. This recommendation is based on evidence from studies which exhibited nearly twice the adjusted odds of death in severe TBI patients treated in non-neurosurgical units compared to those treated in neurosurgical units [2,4].

However, Ireland's Major Trauma Audit (MTA) carried out by the National Office of Clinical Audit (NOCA) in 2018, reported that of 179 patients with severe TBI (defined as GCS ≤8; AIS ≥3) only 50% were transferred to neurosurgical units [5]. Considering the reported increased likelihood of mortality for TBI patients cared for in non-neurosurgical units and the recommendation by NICE, this figure is concerning and warrants further evaluation. Furthermore, a recent study has suggested that the mortality rate of patients with TBI in Ireland is “higher than that reported in international literature” [6]. Although there has been some local research output in recent years with regards to characterising TBIs in Ireland, research into the pathway of TBI referrals and subsequent management still remains scarce [7,8]. The introduction of an electronic system for acute neurosurgical referrals at Beaumont hospital has provided an opportunity to extensively audit and evaluate the management of TBI referrals received by the National Neurosurgical Centre.

The aims of this study were to carry out an audit of all cases of severe TBI referred to the National Neurosurgical Centre at Beaumont Hospital, evaluate the reasons for nonacceptance for transfer to the neurosurgical unit, assess for any differences in the accepted and non-accepted patient cohorts and to determine the mortality rate for severe TBI in Ireland.