Decreasing Regional Neurosurgical Workforce—A Blueprint for Disaster

Smith, Jason W.; Franklin, Glen A.; Miller, Frank B.; Richardson, John D.

doi:10.1097/ta.0b013e3181d990da

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…This point is particularly of importance given the national shortage of neurosurgeons in the USA. This is further accentuated at trauma centers that have no neurosurgical residency programme—further complicating the manpower issues and work burden for neurosurgeons 14–16…”

Section: Discussionmentioning

confidence: 99%

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Cooper

Bethea

Skrobut

et al. 2019

Trauma Surg Acute Care Open

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Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13–15) who presented over a 5-year period (January 2010 to December 2014) to a level I trauma center were identified from the trauma registry. Demographic data, initial CT findings, neurosurgical consultation, follow-up CT findings, Injury Severity Score (ISS), admission GCS and length of stay (LOS) were all obtained from the patient’s charts. Patients with other traumatic brain lesions on the initial CT were excluded. There were 299 patients (male, 48.5%), mean age 60.9 and mean ISS 8. Average time between the first and second CT was 11.3 hours. In all, 267 (89.2%) patients had either no change or an improvement/resolution on follow-up CT scan. Only 26 patients (8.7%) had either worsening or new findings on CT. Eight patients did not have a second scan completed (2.6%). All patients had neurosurgical consultation. Patients with mild TBI with isolated SAH generally have low morbidity, short LOS and negligible mortality. Less than 10% of this population had worsening of their head injury on repeat CT scanning. Given the low acuity of these patients with SAH and tendency towards resolution without intervention, acute care surgeons can manage this specific group of patients with TBI without routine neurosurgical consultation. Repeat CT scanning continues to have utility as it may identify new lesions, deterioration or need for further management.

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Section: Discussionmentioning

confidence: 99%

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Cooper

Bethea

Skrobut

et al. 2019

Trauma Surg Acute Care Open

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“…Studies on the demand and geographical distribution of neurosurgeons were conducted at an interval of years in the United States and Europe, and the problem has been pointed out that neurosurgeons who are able to treat neurosurgical emergent diseases are increasingly concentrated in some large institutions 1 , 4 – 7 , 11 , 14) . However, in Korea, such studies have been led by government affiliated research institutes, and there has been no research or approach from the perspective of neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

Geographic Analysis of Neurosurgery Workforce in Korea

Park

Kim

et al. 2018

J Korean Neurosurg Soc

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ObjectiveIn respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea.MethodsPopulation data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps.ResultsBetween 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000).ConclusionDistribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.

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“…7 Traumatic injuries (other than the primary femur fracture) were classified according to the following categories: head/face, spine, chest, abdomen, pelvis, extremity, and other significant injuries. 8 Data were analyzed using the t test, Pearson x 2 , and Fisher's exact test using SPSS statistical software (v18, IBM, Somers, NY). Unless otherwise stated, data are presented as mean ± standard deviation.…”

Section: Methodsmentioning

confidence: 99%

Closed Midshaft Femur Fractures: Are They Only for Trauma Centers?

Ryan

Carroll

Carter

et al. 2011

The American Surgeon™

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Trauma centers are limited resources, particularly in rural areas, and availability of emergency care in some parts of the United States may be inadequate. The declining number of orthopedic surgeons willing to care for injured patients has limited access to fracture repair in some communities. We studied the management of closed midshaft femur fractures in both trauma centers (TCs) and nontrauma centers (NTCs) to evaluate outcome for this common orthopedic injury and determine if these issues have affected fracture care in Kentucky. All patients 16-years-old and older who suffered femur fractures in Kentucky from 2004 and 2005 were identified. There were 334 TC patients and 341 NTC patients with closed, midshaft femur fractures. The mean age of TC patients (33 ± 17 years) was significantly lower than that of NTC patients (59 ± 25 years). TC patients were more likely men (71% vs 44%), had more associated injuries (2.4 ± 2.1 vs 0.5 ± 1.2), and had longer lengths of stay (8.3 ± 9.8 vs 6.4 ± 7.1 days) (TCs vs NTCs, all P < 0.005). Although both groups ultimately underwent internal fixation (97% vs 99%, TCs vs NTCs), TC patients were more likely (2.7% vs 0.3%) to receive external fixation than the NTC patients ( P < 0.05). There was no significant difference in the percentage of patients that received only a closed reduction. There was no significant difference in hospital mortality (0.3% vs 0.9%, TCs vs NTCs, P = 0.62). Although differences in patient populations exist between TCs and NTCs, both TCs and NTCs manage substantial numbers of patients with closed, midshaft femur fractures with low mortality in this state database.

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Decreasing Regional Neurosurgical Workforce—A Blueprint for Disaster

Cited by 14 publications

References 26 publications

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Geographic Analysis of Neurosurgery Workforce in Korea

Closed Midshaft Femur Fractures: Are They Only for Trauma Centers?

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