title: [Organisation of care and initial management of severe head injury in Spain: Results of a national survey].
abstract: OBJECTIVE
  The main objective of the study is to obtain knowledge about the organisation of care for severe head trauma as well as the initial management of these patients in Neurosurgical Departments in Spain.
  
  
  METHODS
  A 22-item questionnaire was designed and sent to 59 Neurosurgical Departments. The aim of the questionnaire was to collect data regarding the general profile of the patients with a severe head injury, the general characteristics of the hospitals, the initial care of these patients, the monitoring techniques used, and the measures used to control Intracranial pressure (ICP).
  
  
  RESULTS
  Of the 59 Neurosurgical Departments identified, 29 (49.2%) completed the questionnaire. There was a wide variability in the number of patients treated per year between the different departments. The leadership of care often fell (58.6%) on the intensive care specialist. Many (69%) of the departments did not have a neurosurgeon specially dedicated to the management and monitoring of these patients. The initial care in the Emergency department usually fell (51.7%) on the general medicine practitioner. The availability of computed tomography (CT) was universal. The use of telemedicine was highly variable. ICP monitoring was performed on more than 75% of patients in most (89.7%) of departments, but there was limited use of other monitoring techniques. Most Departments followed the recommendations of the Brain Trauma Foundation (BTF) guidelines for the control of ICP.
  
  
  CONCLUSIONS
  The organisation of care and the initial management of severe head trauma in Spain is very similar to its neighbouring countries. However, there are shortcomings, such as low participation by a neurosurgeon in the initial management of these patients, insufficient use of telemedicine, and the low implementation of certain brain monitoring techniques (SjO2, PtiO2, and Doppler).
authors.affiliation: Servicio de Neurocirugía, Hospital General Universitario de Valencia, Valencia, España. Electronic address: v_joanes@hotmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Joanes
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic; D059906:Neuroimaging / Q000706:statistics & numerical data; D009493:Neurosurgery / Q000458:organization & administration; D010348:Patient Care Team / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D013030:Spain / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D017216:Telemedicine / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
keywords: Encuesta; Guidelines; Guías de práctica clínica; Intracranial head injury; Intracranial pressure monitoring; Management; Monitoring; Monitorización; Monitorización de la presión; Survey; Tratamiento; Trauma craneal