Background: Traumatic brain injury (TBI) represents a significant burden of care for acute surgical services, particularly in the absence of on-site neurosurgical cover or sufficient post-acute rehabilitation facilities. We examine factors contributing to TBI, prolonged lengths of stay (LoS) and implications for hospital resources. Long-term outcomes are assessed.Methods: This is a retrospective cohort study of patients admitted to a regional trauma unit with TBI from 2008 to 2013. Patients with LoS>48h were assessed. Demographic, clinical and longitudinal mortality data were collected using electronic clinical and radiological systems and chart review.Results: A total of 690 patients presented with TBI from 2008 to 2013; 213 patients with LoS>48h were assessed. One hundred and thirty (61%) were male. Mean age was 56years (SD 24). Mechanical fall was the most frequent injury mechanism (n=120/213, 56%). Twenty-five per cent were associated with alcohol consumption; these were more likely to be male, involved in an Road Traffic Accident (RTA) or assault and necessitate transfer to a neurosurgical unit (p<0.001, p=0.029, p<0.001, p=0.05). A total of 112 patients(53%) had a prolonged LoS (>2weeks). Mean LoS was 20days (+/- SD 35), increasing to 39days for patients requiring neurosurgical intervention. The 12-month all-cause mortality rate was 12%.Conclusions: TBIs result in significant utilisation of acute inpatient bed days. Improved rehabilitation services and strategies to reduce acute hospital LoS are warranted.