Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Neurosurgical Coverage in Bandung : Essential, Desired, or Irrelevant for Good Trauma Patient Care

Introduction: As a result of many factors, the availability of neurosurgeons (NS) to care for trauma patients (TP) is increasingly sparse. This study examines the profile of head-injured (HI) trauma patients in Bandung and their actual need for the specific expertise of a neurosurgeon. Methods: The Neurosurgical Department, RS. Hasan Sadikin (NDRSHS) data base was queried for specific information relating to the volume, nature, timeliness, and outcome of HI TP from September 2010 – August 2011. Results: Total number of NDRSHS data base patients studied was 5.274, of which 2.342 (44,4%) had a reported HI. Mild HI represented 30,6% of all TP and 68,9% of HI. Moderate HI was reported in 9,3% of all TP and was 20,96% of HI. Severe HI was reported in 4,49% of all TP and was 10,1% of HI. Craniotomy was performed in 133(5,68%) of all HI (2,52% of all TP). Mean Glasgow Coma Scale score (GCS) of craniotomy patients was 9, and 15 for the noncraniotomy group. Subdural hematoma occurred in 11,7% of HI (5,2% of TP), with 13% undergoing crani. Epidural hematoma occurred in 282(12,04%) of HI (5,3% of all TP), with 17% undergoing crani. Intracerebral hematoma occurred in 171(7,3%)of HI (3,2% of all TP). Median time to OR for all craniotomy was 13 hours. No craniotomy was performed within 1 hour of hospital admission. Conclusions: Care of TP with HI rarely requires the explicit expertise and immediate presence of a neurosurgeon due to volume and nature of care. Immediate availability of NS is not essential if a properly trained and credentialed trauma surgeon or other health care provider can appropriately monitor patients for neurologic demise and effect early transfer to a center capable of, and committed to, operative and postoperative neurosurgical care.