Cohn Stephen M, Price Michelle A, Stewart Ronald M, Michalek Joel E, Dent Daniel L, McFarland Marilyn J, Pruitt Basil A
Department of Surgery, The University of Texas Health Science Center at San Antonio, Texas 78229, USA.
J Trauma. 2007 Apr;62(4):951-62; discussion 962-3. doi: 10.1097/01.ta.0000260131.79063.50.
To determine the opinions of neurosurgeons regarding the care of the injured and to assess the impact of these attitudes on the care of the patients with brain injuries.
A survey was sent to the 2,465 active members of the American Association of Neurologic Surgeons. A manpower assessment of neurosurgical coverage of South Texas was also performed.
In total, 872 surveys were returned (35%). Seventy-one percent of the respondents were over the age of 44. Eighty-seven percent of neurosurgeons stated that they currently provide trauma care: 74% at Level I or II trauma centers. The majority of neurosurgeons treated <5 trauma patients per week, 80% placed 2 or fewer intracranial pressure (ICP) monitors per month. Fifty-nine percent of the respondents preferred not to treat trauma patients because of (1) perceived increased medicolegal risk (80%), (2) conflict with elective practice (75%), (3) time required (70%), and (4) inadequate compensation (65%). Fifty-six percent received no compensation for trauma call. The majority of neurosurgeons indicated that no personnel other than neurosurgeons should be allowed to perform trauma craniotomies (90%) or insert ICP monitors (76%). However, 61% thought that non-neurosurgeons should be able to perform neuro-critical care. A maldistribution of neurosurgeons was identified in South Texas, with much of the population uncovered for trauma care. Significant delays in definitive neurosurgical care were identified as a result of this maldistribution.
One-half of neurosurgeons prefer not to care for trauma patients because of perceived added time commitment, conflicts with elective practice, lack of compensation, and perceived medicolegal risk. But, they thought that only neurosurgeons should provide emergency neurosurgical procedures. These attitudes appear to impinge on the care of the patients with brain injuries in South Texas.
确定神经外科医生对受伤患者护理的看法，并评估这些态度对脑损伤患者护理的影响。
向美国神经外科医生协会的2465名在职会员发送了一份调查问卷。还对南德克萨斯州的神经外科覆盖人力进行了评估。
共收回872份调查问卷（35%）。71%的受访者年龄超过44岁。87%的神经外科医生表示他们目前提供创伤护理：74%在一级或二级创伤中心。大多数神经外科医生每周治疗的创伤患者少于5例，80%的医生每月放置的颅内压（ICP）监测器为2个或更少。59%的受访者不愿治疗创伤患者，原因如下：（1）感觉医疗法律风险增加（80%），（2）与择期手术冲突（75%），（3）所需时间（70%），以及（4）补偿不足（65%）。56%的人因创伤值班未获得补偿。大多数神经外科医生表示，除神经外科医生外，不应允许其他人员进行创伤开颅手术（90%）或插入ICP监测器（76%）。然而，61%的人认为非神经外科医生应能够提供神经重症护理。在南德克萨斯州发现神经外科医生分布不均，许多地区缺乏创伤护理服务。由于这种分布不均，确定了确定性神经外科护理存在显著延迟。
由于感觉额外的时间投入、与择期手术冲突、缺乏补偿以及感觉医疗法律风险，一半的神经外科医生不愿护理创伤患者。但是，他们认为只有神经外科医生应提供紧急神经外科手术。这些态度似乎影响了南德克萨斯州脑损伤患者的护理。
