Trial reportBMJ open2017
Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury: findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial.
Trial report in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Transport and destination hospital for patients with suspected multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Pooled it
- Reporting of Race, Ethnicity, Socioeconomic Status, and Educational Attainment in Traumatic Brain Injury Randomised Controlled Trials - How are we doing? A Systematic Review.Journal of racial and ethnic health disparities · 2026Article
- The Impact of Indirect Transport to a Trauma Centre on Survival for Major Trauma Patients: A National Propensity-Adjusted Observational Study.International journal of population data science · 2026Observational
- Optimising prehospital trauma triage for older adults: challenges, limitations, and future directions.Frontiers in medicine · 2025Review
- Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis.Iranian journal of public health · 2023Review
- Traumatic brain injury: progress and challenges in prevention, clinical care, and research.The Lancet. Neurology · 2022Review
- Incidence of emergency neurosurgical TBI procedures: a population-based study.BMC emergency medicine · 2022Article
- A scoping review on the challenges, improvement programs, and relevant output metrics for neurotrauma services in major trauma centers.Surgical neurology international · 2022Article
- Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom.British paramedic journal · 2021Article
- Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Article
- The association between self-declared acute care surgery services and critical care resources: Results from a national survey.Journal of critical care · 2020Article
- Trauma models to identify major trauma and mortality in the prehospital setting.The British journal of surgery · 2020Article
- Delayed Neurosurgical Intervention in Traumatic Brain Injury Patients Referred From Primary Hospitals Is Not Associated With an Unfavorable Outcome.Frontiers in neurology · 2020Article
- A retrospective review of patients with significant traumatic brain injury transported by emergency medical services within the south east of England.British paramedic journal · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
objectiveReconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)-bypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) may worsen outcomes when compared with selective secondary transfer from nearest NSAH to SNC. We conducted a pilot cluster randomised controlled trial to determine the feasibility and plausibility of bypassing suspected patients with TBI -directly into SNCs-producing a measurable effect.
settingTwo English Ambulance Services.
participants74 clusters (ambulance stations) were randomised within pairs after matching for important characteristics. Clusters enrolled head-injured adults-injured nearest to an NSAH-with internationally accepted TBI risk factors and stable ABC. We excluded participants attended by Helicopter Emergency Medical Services or who were injured more than 1 hour by road from nearest SNC.
interventionsIntervention cluster participants were transported directly to an SNC bypassing nearest NSAH; control cluster participants were transported to nearest NSAH with selective secondary transfer to SNC. OUTCOMES: Trial recruitment rate (target n=700 per annum) and percentage with TBI on CT scan (target 80%) were the primary feasibility outcomes. 30-day mortality, 6-month Extended Glasgow Outcome Scale and quality of life were secondary outcomes.
results56 ambulance station clusters recruited 293 patients in 12 months. The trial arms were similar in terms of age, conscious level and injury severity. Less than 25% of recruited patients had TBI on CT (n=70) with 7% (n=20) requiring neurosurgery. Complete case analysis showed similar 30-day mortality in the two trial arms (control=8.8 (2.7-14.0)% vs intervention=9.4(2.3-14.0)%).
conclusionBypassing patients with suspected TBI to SNCs gives an overtriage (false positive) ratio of 13:1 for neurosurgical intervention and 4:1 for TBI. A measurable effect from a full trial of early neuroscience care following bypass is therefore unlikely. TRIAL REGISTRATION NUMBER: ISRCTN68087745.
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