Care for patients with head injuries does not match standards set down two years ago, research suggests.

Two separate audits of hospitals, published in the Emergency Medicine Journal indicated "major deficiencies" in the service.

The researchers said patients were not getting the care they should receive.

Funding, staff and the way the service was provided all fell short of the standards desired, they said.

In addition, rehabilitation services and follow-up care for patients with head injuries were poor, and levels of care varied considerably.

Staff shortages

The reports compared standards of services with those set out in a Royal College of Surgeons of England (RCSE) report in June 1999, and a further report from the Society of British Neurological Surgeons in February 2000.

One study looked at 20 acute hospitals and two neurosurgical units in the Eastern region, which covers the area from Norfolk to Bedfordshire.

The second assessed just over 200 A&E units across the UK.

Just six hospitals in the Eastern Region said they had enough consultants.

Only one in four felt they had sufficient numbers of other medical staff.

To reach recommended staffing levels, consultant numbers would have to be increased by over 70%.

Only five hospitals had observation wards for patients with minor head injuries. Half had no space to include such a ward.

Only two hospitals allocated beds for patients with moderate head injuries, and there was little interest or expertise in treating them.

All the hospitals had Computerised Tomography (CT) scanning facilities - which take a kind of 3-D x-ray - but more than a third complained of access problems because of lack of resources or radiologists.

Specialist neurological care for patients who needed care for longer than 48 hours was only available at Addenbrooke's Hospital, Cambridge.

But one in six patients with head injuries requires more than 48 hours in hospital, and one in 20 stay more than a week.

Accident and Emergency

The UK-wide survey of members of the British Association for Accident and Emergency Medicine, covered 206 A&E departments out of a possible 256.

It indicated that more than half of head injury care is provided by general or orthopaedic surgeons, and not neurosurgeons, as recommended by the RCSE.

Only a third of A&E consultants were involved to some degree in the care of head injuries, as is recommended in the report.

Another third were willing to assume responsibility, but did not have the resources to do so.

In addition, a third said it was often difficult to find specialist beds.

Writing in the Emergency Medicine Journal, the Cambridge-based researchers who carried out the study in the Eastern region said the RCSE report would have a "profound effect" on the management of head injuries across the UK - if it was implemented.

They wrote that their study had "clearly shown major deficiencies in A&E resources, care of moderate head injuries and rehabilitation and follow up of patients".

"The RCSE report recommendations are very desirable but without resources and refinement, the recommendations cannot be implemented."