A total of 21 consecutive referrals with multiple injuries (Injury Severity Score (ISS) 17-66), admitted into the Regional Neurosurgical Unit (RNSU) over a 1-year period from August 1989, was analysed to evaluate the risks associated with transfer of such patients from district general hospitals within the North West Thames Region. Injury assessment was deficient in nine cases. Four developed hypovolaemic shock during transfer, and in five resuscitation was inadequate. Four had minor head injuries and two had no head injury; of these cases, one died. There were four fatalities: the mean ISS in this group was 42, and in all cases deficiencies in resuscitation and assessment before transfer were identified. There were seven major missed injuries. All patients had musculoskeletal injuries and 16 required orthopaedic intervention within 6 h. Interhospital transfer of this group of patients carries significant risks, may be unnecessary, and may delay other surgical priorities.