创伤外科医生成功放置颅内压监测器。

Successful placement of intracranial pressure monitors by trauma surgeons.

机构信息

From the Section of Acute Care Surgery (A.P.E., S.I., J.S., M.W., P.P., M.C.M.), Department of Surgery, and Department of Neurosurgery (J.S.S.), Wright State University School of Medicine, Dayton, Ohio.

出版信息

J Trauma Acute Care Surg. 2014 Feb;76(2):286-90; discussion 290-1. doi: 10.1097/TA.0000000000000092.

DOI:10.1097/TA.0000000000000092

PMID:24458035

Abstract

BACKGROUND

The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons.

METHODS

In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student's t tests.

RESULTS

During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951).

CONCLUSION

After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications.

LEVEL OF EVIDENCE

Therapeutic/care management study, level IV.

摘要

背景

颅脑外伤基金会指南主张对格拉斯哥昏迷评分（GCS）≤8 分且 CT 扫描异常的创伤性脑损伤（TBI）患者使用颅内压（ICP）监测。如果 24 小时内没有神经外科医生在场，可能会对及时放置监测器产生负面影响。我们对接受过神经外科医生培训和认证的创伤外科医生进行 ICP 监测器放置的安全性进行了回顾。

方法

2005 年，一级创伤中心的院内创伤外科医生接受了神经外科医生的 ICP 脑实质监测器放置培训和认证。我们提取了所有在 6 年期间接受 ICP 监测器放置的 TBI 患者。确定了人口统计学信息、损伤严重程度评分（ISS）、结果以及由神经外科或创伤外科进行的监测器放置情况。将错位、出血、感染、故障和脱位视为并发症。通过卡方检验和学生 t 检验进行比较。

结果

在 6 年期间，共为 TBI 患者放置了 410 个 ICP 监测器。患者的平均（标准差）年龄为 40.9（18.9）岁，73.7%为男性，平均（标准差）ISS 为 28.3（9.4），平均（标准差）住院时间为 19（16）天，死亡率为 36.1%。机动车事故和跌倒分别是最常见的损伤机制（分别为 35.2%和 28.7%）。创伤外科医生放置了 71.7%的 ICP 监测器，其余的由神经外科医生放置。神经外科医生在手术室中为大多数患者（71.8%）进行了 ICP 监测器的放置，主要是在开颅手术期间。总的并发症发生率为 2.4%。创伤外科医生和神经外科医生之间的并发症发生率没有显著差异（3%与 0.8%，p=0.2951）。