Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10246
Title: Emergency neurosurgery by general surgeons at a remote major hospital.
Authors: Treacy, P John
Reilly, Peter
Brophy, Brian
Affiliation: Northern Territory Clinical School, Royal Darwin Hospital, Australia. john.treacy@nt.gov.au.
Issue Date: Oct-2005
Citation: ANZ journal of surgery 2005-10; 75(10): 852-7
Abstract: Due to the geographical remoteness of Darwin, which has no resident neurosurgeon, emergency transfer of patients for neurosurgery is usually impractical. In Darwin emergency neurosurgery must be undertaken by general surgeons. Data from the operating theatre, Emergency Department and Intensive Care Unit were prospectively recorded on all patients who underwent an emergency neurosurgical procedure between January 1992 and June 2004. Outcomes were assessed by retrospective case note review. Three hundred and five neurosurgical procedures were performed upon 258 patients (average 26.5 procedures per year), including 130 craniotomies, 88 burr holes, 3 posterior fossa craniotomies, 2 decompressive frontal lobectomies, 4 decompressive craniectomies, 25 elevations of fracture and 33 ventricular drains only. Assault/domestic incident (31%) was a more common aetiology than motor vehicle accidents (29%). Outcome was best for extradural haematoma (82% good/moderate) and chronic subdural haematoma (84% good/moderate). In contrast, 44% with acute subdural haematoma and 77% with intracerebral haematoma died. Irrespective of type of bleed, Glasgow Coma Scale (GCS) score at presentation was a reliable predictor of outcome following surgery (61% correlation): 60% with GCS less than 9 died whereas 79% with GCS over 11 had a good recovery. Acute Physiology And Chronic Health Evaluation, version 2 and Simplified Acute Physiology Score, version 2 scores were also independent predictors of outcome. Time from presentation to operation for extradural haematoma and acute subdural haematoma was prolonged (more than 4 h) in 48% and was associated with worse outcome (P = 0.0001). Neither extremes of age nor the particular surgeon performing the operation affected outcome. General surgeons undertake a substantial number of procedures across a broad spectrum of emergency neurosurgery in Darwin. Outcomes following surgery appear acceptable.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10246
DOI: 10.1111/j.1445-2197.2005.03549.x
ISSN: 1445-1433
Type: Comparative Study
Journal Article
Subjects: APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Australia
Chi-Square Distribution
Child
Craniocerebral Trauma
Data Interpretation, Statistical
Female
Glasgow Coma Scale
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies
Treatment Outcome
Emergency Service, Hospital
Neurosurgical Procedures
Rural Health Services
Surgery Department, Hospital
Appears in Collections:NT Health digital library

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