title: Placement of intracranial pressure monitors by non-neurosurgeons: excellent outcomes can be achieved.
abstract: BACKGROUND
  Traumatic brain injury remains one of the most prevalent and costly injuries encountered within the discipline of trauma and represents a leading cause of morbidity and mortality within our society. The purpose of this study was to compare the safety of intracranial pressure (ICP) monitor placement by general surgery residents and neurosurgeons.
  
  
  METHODS
  A retrospective chart review of all trauma patients requiring ICP monitor placement at an American College of Surgeons-verified Level 1 trauma center during a 10-year period was performed. Comparison of demographic variables, injury severity, intracranial injuries, incidence of ICP monitor-related complications, and outcomes were made between general surgery residents, trauma surgeons, and neurosurgeons.
  
  
  RESULTS
  There were 546 patients included in the study. The average age of the cohort was 37.6 years, with an average hospital length of stay being 16.0 days and an Injury Severity Score of 27.7. Mechanisms of injury varied, but 58.8% was a result of motor vehicle and motorcycle collisions, and an additional 19.2% was a result of falls. No significant difference was found in terms of procedure-related complications between subgroups, including intracranial hemorrhage, infection, malfunctions, dislodgment, or death.
  
  
  CONCLUSIONS
  Our results demonstrate that the placement of ICP monitors may be performed safely by both neurosurgeons and non-neurosurgeons. This procedure should thus be considered a core skill for trauma surgeons and surgical residents alike, thereby allowing initiation of prompt medical treatment in both rural areas and trauma centers with inadequate neurosurgeon or fellow coverage.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, Kansas 67214, USA.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Barber
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Helmer
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Morgan
authors.forename: James M
authors.initials: JM
authors.lastname: Haan
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D007427:Intracranial Pressure; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000295:instrumentation*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D061214:Patient Safety; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult