Peselzon Oleg, Toro Tole David, Rissel Chris, Kamat Ameya, Maclachlan Liam, Redmond Michael
1Department of Neurosurgery, Royal Darwin Hospital, Darwin, Northern Territory.
2College of Medicine and Public Health, Flinders NT, Darwin, Northern Territory; and.
J Neurosurg. 2024 Nov 15;142(4):1176-1183. doi: 10.3171/2024.6.JNS232599. Print 2025 Apr 1.
The authors' goal was to perform a retrospective audit of all emergency cranial neurosurgery performed at the Royal Darwin Hospital in the first 5 years of the unit and to compile their data in a similar fashion to an earlier study titled "Emergency Neurosurgery in Darwin: Still the Generalist Surgeons' Responsibility," which was published in 2015.
All emergency cranial neurosurgery performed by a neurosurgeon between 2017 and 2021 was identified. Data were extracted from the National Critical Care and Trauma Response Centre database. Statistical analyses were descriptive logistic regression performed using Stata version 15.1 software to examine factors associated with death.
A total of 320 patients (42% Indigenous) underwent 427 emergency neurosurgeries. There were 35 emergency neurosurgeries in 2017 and 82 in 2021. The most common procedure performed was insertion of an external ventricular drain, followed by craniotomy and removal of intracranial hematoma. Mortality was 7.5% overall and 8.4% among patients with trauma. Only age proved to be a statistically significant independent risk factor for death (t = -2.95, p < 0.0041; OR 1.06, p = 0.02). Location, sex, injury severity, and presenting Glasgow Coma Scale score were not associated with death. Indigenous and non-Indigenous patients had similar outcomes.
The data illustrate the importance of developing small but sustainable neurosurgical units in rural and remote areas. A dedicated neurosurgical unit at the Royal Darwin Hospital has led to an increase in the amount and variety of emergency neurosurgery performed in Darwin. Interstate transfers have reduced. This has tangible lifesaving and economic advantages.
作者的目标是对皇家达尔文医院神经外科单元成立后的头5年里所进行的所有急诊颅脑神经外科手术进行回顾性审计，并以与2015年发表的一项名为《达尔文的急诊神经外科手术：仍是普通外科医生的职责》的早期研究类似的方式汇编数据。
确定了2017年至2021年间神经外科医生进行的所有急诊颅脑神经外科手术。数据从国家重症监护和创伤反应中心数据库中提取。使用Stata 15.1软件进行描述性逻辑回归统计分析，以检查与死亡相关的因素。
共有320例患者（42%为原住民）接受了427例急诊神经外科手术。2017年有35例急诊神经外科手术，2021年有82例。最常进行的手术是插入外部脑室引流管，其次是开颅手术和清除颅内血肿。总体死亡率为7.5%，创伤患者死亡率为8.4%。只有年龄被证明是死亡的统计学上显著的独立危险因素（t = -2.95，p < 0.0041；OR 1.06，p = 0.02）。位置、性别、损伤严重程度和入院时格拉斯哥昏迷量表评分与死亡无关。原住民和非原住民患者的结果相似。
数据说明了在农村和偏远地区建立规模虽小但可持续的神经外科单元的重要性。皇家达尔文医院专门的神经外科单元使达尔文进行的急诊神经外科手术的数量和种类有所增加。州际转诊减少。这具有切实的挽救生命和经济优势。
