Skip to main content

Advertisement

SpringerLink
Log in

Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals: A regional study

  • Clinical Article - Brain Injury
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

Method

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.

Findings

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bellander BM, Sollid S, Koch-Jensen C, Juul N, Eskanen V, Sundstrøm T, Wester K, Romner B (2008) Prehospital handläggning av patienter med svår skallskada. Skandinaviska riktlinjer enligt Brain Trauma Foundation. Lakartidningen 105(24–25):1834–1838

    PubMed  Google Scholar 

  2. Carmont MR (2005) The Advanced Trauma Life Support course: a history of its development and review of related literature. Postgrad Med J 81(952):87–91

    Article  CAS  PubMed  Google Scholar 

  3. Jacobsson LJ, Westerberg M, Lexell J (2007) Demoghraphics, injury charachteristics and outcome of traumatic brain injuries in northern Sweden. Acta Neurologica Scandinavica 116(5):300–306

    Article  CAS  PubMed  Google Scholar 

  4. Jennet B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7905):480–484

    Article  Google Scholar 

  5. Johnstone AJ, Lohlun JC, Miller JD, McIntosh CA, Gregori A, Brown R, Jones PA, Anderson SI, Tocher JL (1993) A comparison of the Glasgow Coma Scale and the Swedish Reaction Level Scale. Brain Injury BI 7(6):501–506

    Article  CAS  PubMed  Google Scholar 

  6. Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE (2005) Trends in head injury outcome from 1989 to 2003 and the effect of neurosurcical care: an observational study. Lancet 366(9496):1538–1544

    Article  CAS  PubMed  Google Scholar 

  7. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC (1981) Traumatic acute subdural haematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 304(25):1511–1518

    Article  CAS  PubMed  Google Scholar 

  8. Sollid S, Sundstrøm T, Ingebrigtsen T, Romner B, Wester K (2009) Organisation of traumatic head injury management in the Nordic countries. Emer med j EMJ 26(11):769–772

    Article  CAS  Google Scholar 

  9. Stålhammar D, Starmark JE, Holmgren E, Eriksson N, Nordström CH, Fedders O, Rosander B (1988) Assessment of responsiveness in acute cerebral disorders. A multicentre study on Reaction Level Scale (RLS 85). Acta Neurochir (Wien) 90(3–4):73–80

    Article  Google Scholar 

  10. Steiner LA, Andrews PJD (2006) Monitoring the injured brain: ICP and CBF. Br J Anaesth 97(1):26–38

    Article  CAS  PubMed  Google Scholar 

  11. Teasdale GM, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2(7872):81–84

    Article  CAS  PubMed  Google Scholar 

  12. Teasdale GM, Pettigrew LE, Wilson JT, Murray G, Jennet B (1998) Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma 15(8):587–597

    Article  CAS  PubMed  Google Scholar 

  13. Wester T, Fevang LT, Wester K (1999) Decompressive surgery in acute head injuries: where should it be performed? The Journal of Trauma: Injury, Infection and Critical Care 46(5):914–919

    Article  CAS  Google Scholar 

  14. Wilson JT, Pettigrew LE, Teasdale GM (1998) Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: Guidelines for Their Use. J Neurotrauma 15(8):573–585

    Article  CAS  PubMed  Google Scholar 

  15. Wilson JT, Pettigrew LE, Teasdale GM (2000) Emotional and cognitive consequences of head injury in relation to the Glasgow outcome scale. J Neurol Neurosurg Psychiatr 69(2):204–209

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The hospitals in the Uppsala-Örebro health care region are acknowledged for their good collaboration.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neuroscience, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden

    Ann Fischerström, Lena Nyholm, Anders Lewén & Per Enblad

Authors
  1. Ann Fischerström
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lena Nyholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anders Lewén
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Per Enblad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Per Enblad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischerström, A., Nyholm, L., Lewén, A. et al. Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals: A regional study. Acta Neurochir 156, 177–185 (2014). https://doi.org/10.1007/s00701-013-1932-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1932-5

Keywords

Search

Navigation