Do we need neurosurgical coverage in the trauma center?
The undersupply and maldistribution of neurosurgeons coupled with the apparent abandonment of trauma care by a significant number of rank and file neurosurgeons, and perhaps an over demand for their services, has created a crisis in access to neurotrauma care across the country. There is evidence to support that the immediate availability of a neurosurgeon to participate in the care of all trauma patients, including those who have documented head injury, may not be essential to providing optimal care, calling the American College of Surgeons' mandated criterion for trauma center verification into question. Given the volume, nature, and timeliness of head injury and its care, it seems this crisis can be resolved to a great extent by having trauma surgeons or other properly trained, credentialed, and monitored providers assume nonoperative, in-patient neurotrauma care when hospital admission is actually indicated. Although part of the solution lies in increased supply of neurotrauma services regardless of provider type, a second component rests in decreasing demand for these services in cases of mild and extremely severe head injury. Such a solution seems feasible and advantageous in several respects and should be seriously considered by healthcare policy makers, trauma system planners, and the leaders of the neurosurgical and trauma surgery disciplines. What is truly needed in hospitals treating trauma patients (ie, trauma centers) is a philosophy centered on patient services rather than the specific provider. What is needed is a provider who is committed, capable, and competent, who recognizes and meets the patients' needs and provides the appropriate services. These providers, regardless of pedigree, must be supported and valued by the healthcare system and society. In the future this may require regionalization of services. In some hospitals and systems the primary person responsible for providing these services will be a neurosurgeon. In others, it may not and perhaps need not be.
Esposito
Thomas J
TJ
Loyola University Medical Center, Department of Surgery, 2160 South First Avenue, Building 110, Maywood, IL 60153, USA. tesposi@lumc.edu
Luchette
Fred A
FA
Gamelli
Richard L
RL
D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000601:surgery; D003399:Craniotomy; D006801:Humans; D009493:Neurosurgery; D012042:Registries; D014193:Trauma Centers / Q000592:standards; D014481:United States; D000078329:Workforce