Luck Tara, Treacy Peter John, Mathieson Matthew, Sandilands Jessica, Weidlich Stephanie, Read David
Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Department of Anaesthetics, Modbury Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2015 Sep;85(9):610-4. doi: 10.1111/ans.13138. Epub 2015 Apr 28.
Royal Darwin Hospital (RDH) is the only major hospital for the 'Top End' of Northern Territory and Western Australia. As retrieval distances exceed 2600 km, resident generalist surgeons undertake all emergency neurosurgery.
Retrospective clinical study from RDH records and review of prospectively collected datasets from RDH Intensive Care Unit and National Critical Care Trauma Response Centre for all emergency neurosurgery patients between 2008 and 2013.
Data were obtained from 161 patients with 167 admissions (73% male, 39% indigenous) who underwent 195 procedures (33 per year), including burr hole, craniotomy, cerebral and posterior fossa craniectomy, elevation fracture and ventricular drain. Trauma accounted for 68%, with alcohol as a known factor in 57%. Subdural haematoma (SDH) accounted for 53%. Severity of head injury at presentation correlated with outcome (R(2) = 0.12, P < 0.001). Factors associated with death included injury at remote location (P = 0.022), time injury to operation >24 h (P = 0.023) and specific diagnoses of acute SDH (P = 0.006), acute-on-chronic SDH (P = 0.053) and infection (P = 0.052). Indigenous patients were younger (40 versus 55 years, P < 0.001) and more likely to have alcohol as a factor in trauma cases (71% versus 49%, P = 0.027). Time from injury to hospital was high for accidents at a remote location (12.9 versus 1.3 h, P < 0.001); however, Glasgow Outcome Scales (P = 0.13) were no different to accident at metropolitan Darwin.
General surgeons at RDH perform a wide range of emergency neurosurgical procedures primarily for trauma. Factors contributing to poor outcomes included remote location of trauma and delay in reaching the hospital. Outcomes at 3 months appear acceptable.
皇家达尔文医院（RDH）是北领地和西澳大利亚“顶端地区”唯一的大型医院。由于转运距离超过2600公里，住院普通外科医生承担所有急诊神经外科手术。
对RDH的记录进行回顾性临床研究，并对2008年至2013年间所有急诊神经外科患者的前瞻性收集数据集进行回顾，这些数据集来自RDH重症监护病房和国家重症监护创伤反应中心。
数据来自161例患者的167次入院（73%为男性，39%为原住民），共进行了195例手术（每年33例），包括钻孔、开颅、脑和后颅窝颅骨切除术、抬高骨折和脑室引流。创伤占68%，其中57%已知酒精是一个因素。硬膜下血肿（SDH）占53%。就诊时的头部损伤严重程度与预后相关（R² = 0.12，P < 0.001）。与死亡相关的因素包括创伤发生在偏远地区（P = 0.022）、受伤至手术时间>24小时（P = 0.023）以及急性SDH（P = 0.006）、慢性硬膜下血肿急性发作（P = 0.053）和感染（P = 0.052）的特定诊断。原住民患者更年轻（40岁对55岁，P < 0.001），在创伤病例中更有可能以酒精为一个因素（71%对49%，P = 0.027）。偏远地区事故的受伤至医院时间较长（12.9小时对1.3小时，P < 0.001）；然而，格拉斯哥预后量表（P = 0.13）与达尔文市事故无差异。
RDH的普通外科医生主要针对创伤进行广泛的急诊神经外科手术。导致不良预后的因素包括创伤发生在偏远地区以及到达医院的延迟。3个月时的预后似乎可以接受。
