Severe traumatic brain injury in NSW: Outcomes similar for rural and urban residents

Dr Peter Harradine, senior staff specialist in rehabilitation medicine and director of rehabilitation and aged care services at the Tamworth Base Hospital, New England Area Health Service, co-authored the research, which suggests that the integrated network of inpatient, outpatient and outreach services provided throughout NSW through the Brain Injury Rehabilitation Program has led to the positive findings.

Previous research reported poorer outcomes after TBI for rural residents.

"NSW has a critical care network, better developed in some areas of the state than others, to assist in early retrieval of seriously injured patients to rural base hospital intensive care units and to urban neurosurgical units when required," Dr Harradine said.

The Brain Injury Rehabilitation Program for NSW is unique in that there is an extensive state-wide network of services, with three specialised adult inpatient brain injury units in Sydney and eight regional brain injury rehabilitation programs, including one in Wollongong and one in Newcastle.

Dr Harradine said rural units tend to focus on rehabilitation and community integration through transitional living units (TLUs) and outpatient and outreach services.

While the results of the study are encouraging, challenges remain for rural patients.

Dr Harradine said problems with recruiting and retaining healthcare professionals in rural areas are well known, and the ability of rural healthcare professionals to deal with complex issues arising from TBI may be limited by time and lack of access to other services.

"Access to psychiatric and psychological resources is quite limited in rural areas, and this can lead to difficulties dealing with the ongoing challenging behaviours and cognitive impairment that may result from TBI," Dr Harradine said.

"Patients transferred to urban inpatient units may spend many months away from their homes. Appropriate accommodation, social support and financial assistance for carers is essential for maintaining social attachments and interpersonal relationships.

"Given the isolation and resource limitations of rural populations, it is significant that we found comparable outcomes for rural and urban patients after TBI. The Brain Injury Rehabilitation Program model would be suitable for adoption in the planning, provision and delivery of other healthcare services," Dr Harradine said.

The Medical Journal of Australia is a publication of the Australian Medical Association.