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Brain Injury

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Most of the serious trauma victims seen in emergency rooms are cases involving motor vehicle accidents. A new study may help change the quality of care for those patients who suffer a brain injuries in such accidents. The conclusion of the study finds that neurosurgeons are rarely needed to intervene. Given the number of traumas and the limited number of neurosurgeons, the study suggests that trauma surgeons be trained in evaluating patients for braiin injury and be qualified to render a number of treatments that now entail the involvement of a neurosurgeon.

Investigators studied this question with the National Trauma Data Bank maintained by the American College of Surgeons. Of the nearly 732,000 patients in the data bank, 29% had a head injury diagnosis, and, of these head-injured patients, only 3.6% required a craniotomy. The median time from injury to craniotomy was 195 minutes, and only 6.5% of craniotomies were performed within 1 hour. In view of the infrequent need for neurosurgical skills, the study authors conclude that immediate access to a neurosurgeon is not required if trauma surgeons or other healthcare providers can appropriately evaluate and monitor head injury patients.
With only about 3400 neurosurgeons in the United States, it is difficult to imagine how such a small group of specialists can supervise the care of an estimated 1.5 million annual head injury patients. The study authors suggest that trauma surgeons should be trained not only in the evaluation of head injuries, but also in some of the more common procedures, such as insertion of intracranial pressure monitors and even drainage of epidural and subdural hematomas. This is clearly a controversial topic, needing additional studies to determine how trauma centers should manage the complicated manpower issues related to the care of patients with head injuries.