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Title of Journal: Acta Neurochir

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Abbravation: Acta Neurochirurgica

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Springer Vienna

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DOI

10.1007/bf03078164

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0942-0940

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Acute neurosurgery for traumatic brain injury by g

Authors: Ann Fischerström Lena Nyholm Anders Lewén Per Enblad
Publish Date: 2013/11/24
Volume: 156, Issue: 1, Pages: 177-185
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Abstract

Traditionally acute lifesaving evacuations of extracerebral haematomas are performed by general surgeons on vital indication in county hospitals in the UppsalaÖrebro health care region in Sweden a region characterized by long distances and a sparsely distributed population Recently it was stated in the guidelines for prehospital care of traumatic brain injury from the Scandinavian Neurosurgical Society that acute neurosurgery should not be performed in smaller hospitals without neurosurgical expertiseThe aim of this study was to investigate how often does acute decompressive neurosurgery occur in county hospitals in the UppsalaÖrebro region today what is the indication for surgery and what is the clinical outcome Finally the goal was to evaluate whether the current practice in the UppsalaÖrebro region should be revisedPatients referred to the neurointensive care unit at the Department of Neurosurgery in Uppsala after acute evacuation of intracranial haematomas in the county hospitals 2005–2010 were included in the study Data was collected retrospectively from the medical records following a predefined protocol The presence of vital indication radiological and clinical results and longterm outcome were evaluatedA total of 49 patients 17 epidural haematomas and 32 acute subdural haematomas were included in the study The operation was judged to have been performed on vital indication in all cases The postoperative CT scan was improved in 92  of the patients The reaction level and pupillary reactions were significantly improved after surgery Longterm outcomes showed 51  favourable outcome 33  unfavourable outcome and in 16  the outcome was unknownLooking at the indication for acute neurosurgery the postoperative clinical and radiological results and the longterm outcome it appears that our regional policy regarding lifesaving decompressive neurosurgery in county hospitals by general surgeons should not be changed We suggest a curriculum aimed at educating general surgeons in acute neurosurgery

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