American Surgical Association
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9. Neurosurgical Coverage: Essential, Desired, Or Irrelevant For Good Patient Care and Trauma Center Status
Fred A. Luchette, MD*, Thomas J. Esposito, MD*, R. Lawrence Reed, MD*, Richard L. Gamelli, MD
Division of Trauma, Critical Care & Burns, Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL

Introduction: As a result of multiple factors, neurosurgeons (NS) are frequently unavailable to care for trauma patients (TP). This study examines the profile of head injured (HI) TP and the actual need for a NS.
Methods: The National Trauma Data Bank (NTDB) was queried for information relating to volume, nature, timeliness and outcome of care for HI TP. Study patients were identified by ICD-9 codes denoting open (OHI) or closed head injury (CHI).
Results: There were 731,823 TP in the NTDB. 213,357 (29%) were diagnosed with a HI. CHI represented 22% of all TP and 74% of HI. OHI was reported in 8% of all TP and was 26% of HI. Craniotomy was performed in 3.6% of HI (1% of TP). This was 2.8% in OHI and 2.6% in CHI. Mean GCS of craniotomy patients was 9 and 13 for the non craniotomy group. Subdural hematoma occurred in 18% of HI (5% of TP) with 13% undergoing craniotomy. Epidural hematoma occurred in 10% of HI (3% of all TP) with 17% undergoing craniotomy. Median time to craniotomy was 195 minutes (195 for CHI; 183 for OHI). 91% of all craniotomies were performed > 1 hour after admisison. ICP monitoring was utilized in 0.7% of TP and 2.2% of HI.
Conclusions: Over 95% of HI TP require non operative management. Only 1% of all TP required a craniotomy. Trauma surgeons trained in nonoperative management of HI TP and ICP monitor placement can provide initial care for over 96% of TP.

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