title: Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals: a regional study.
abstract: BACKGROUND
  Traditionally acute life-saving evacuations of extracerebral haematomas are performed by general surgeons on vital indication in county hospitals in the Uppsala-Örebro health care region in Sweden, a region characterized by long distances and a sparsely distributed population. Recently, it was stated in the guidelines for prehospital care of traumatic brain injury from the Scandinavian Neurosurgical Society that acute neurosurgery should not be performed in smaller hospitals without neurosurgical expertise. The aim of this study was to investigate: how often does acute decompressive neurosurgery occur in county hospitals in the Uppsala-Örebro region today, what is the indication for surgery, and what is the clinical outcome? Finally, the goal was to evaluate whether the current practice in the Uppsala-Örebro region should be revised.
  
  
  METHODS
  Patients referred to the neurointensive care unit at the Department of Neurosurgery in Uppsala after acute evacuation of intracranial haematomas in the county hospitals 2005-2010 were included in the study. Data was collected retrospectively from the medical records following a predefined protocol. The presence of vital indication, radiological and clinical results, and long-term outcome were evaluated.
  
  
  RESULTS
  A total of 49 patients (17 epidural haematomas and 32 acute subdural haematomas) were included in the study. The operation was judged to have been performed on vital indication in all cases. The postoperative CT scan was improved in 92% of the patients. The reaction level and pupillary reactions were significantly improved after surgery. Long-term outcomes showed 51% favourable outcome, 33% unfavourable outcome, and in 16% the outcome was unknown.
  
  
  CONCLUSIONS
  Looking at the indication for acute neurosurgery, the postoperative clinical and radiological results, and the long-term outcome, it appears that our regional policy regarding life-saving decompressive neurosurgery in county hospitals by general surgeons should not be changed. We suggest a curriculum aimed at educating general surgeons in acute neurosurgery.
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Ann
authors.initials: A
authors.lastname: Fischerström
authors.forename: Lena
authors.initials: L
authors.lastname: Nyholm
authors.forename: Anders
authors.initials: A
authors.lastname: Lewén
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: D000293:Adolescent; D000368:Aged; D001930:Brain Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006766:Hospitals, County; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult