Successful placement of intracranial pressure monitors by trauma surgeons.
BACKGROUND
The Brain Trauma Foundation guidelines advocate for the use of intracranial pressure (ICP) monitoring following traumatic brain injury (TBI) in patients with a Glasgow Coma Scale (GCS) score of 8 or less and an abnormal computed tomographic scan finding. The absence of 24-hour in-house neurosurgery coverage can negatively impact timely monitor placement. We reviewed the safety profile of ICP monitor placement by trauma surgeons trained and credentialed in their insertion by neurosurgeons.


METHODS
In 2005, the in-house trauma surgeons at a Level I trauma center were trained and credentialed in the placement of ICP parenchymal monitors by the neurosurgeons. We abstracted all TBI patients who had ICP monitors placed during a 6-year period. Demographic information, Injury Severity Score (ISS), outcome, and monitor placement by neurosurgery or trauma surgery were identified. Misplacement, hemorrhage, infections, malfunctions, and dislodgement were considered complications. Comparisons were performed by χ testing and Student's t tests.


RESULTS
During the 6-year period, 410 ICP monitors were placed for TBI. The mean (SD) patient age was 40.9 (18.9) years, 73.7% were male, mean (SD) ISS was 28.3 (9.4), mean (SD) length of stay was 19 (16) days, and mortality was 36.1%. Motor vehicle collisions and falls were the most common mechanisms of injury (35.2% and 28.7%, respectively). The trauma surgeons placed 71.7 % of the ICP monitors and neurosurgeons for the remainder. The neurosurgeons placed most of their ICP monitors (71.8%) in the operating room during craniotomy. The overall complication rate was 2.4%. There was no significant difference in complications between the trauma surgeons and neurosurgeons (3% vs. 0.8%, p = 0.2951).


CONCLUSIONS
After appropriate training, ICP monitors can be safely placed by trauma surgeons with minimal adverse effects. With current and expected specialty shortages, acute care surgeons can successfully adopt procedures such as ICP monitor placement with minimal complications.


METHODS
Therapeutic/care management study, level IV.
From the Section of Acute Care Surgery (A.P.E., S.I., J.S., M.W., P.P., M.C.M.), Department of Surgery, and Department of Neurosurgery (J.S.S.), Wright State University School of Medicine, Dayton, Ohio.
Akpofure Peter
AP
Ekeh
Sadia
S
Ilyas
Jonathan M
JM
Saxe
Melissa
M
Whitmill
Priti
P
Parikh
Jeffrey S
JS
Schweitzer
Mary C
MC
McCarthy
D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002983:Clinical Competence; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure; D008297:Male; D008365:Manometry / Q000295:instrumentation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D019635:Neurosurgical Procedures / Q000193:education* / Q000295:instrumentation; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013043:Specialties, Surgical / Q000193:education; D015996:Survival Rate; D014193:Trauma Centers; D055815:Young Adult