Management of Patients with Neurotrauma by Trauma Surgeons: Need of the Hour

Abstract

Trauma-related deaths in excess of 1 million occur annually in India, more than half of which are attributable to head injury. There are just 1,400 certified neurosurgeons in India, and only 300 new trainees are inducted every year. More than 80% of India’s specialist doctors live in urban India. There is evidence that patients travel hundreds of kilometers to seek a neurosurgeon; needless to say, golden hour of trauma is surely lost in this time. Scarcity of neurosurgeons is a problem in the developed world too. Government of India is building a national network of trauma centers for better trauma care. However, neurosurgeon availability at these centers remains a cause of concern. In dire need of neurotrauma management and scarcity of neurosurgeons, management of neurotrauma by trauma and general surgeons is the best available option. Such management policies have already been tested successfully in both developed (Germany, Sweden) and developing world (Nepal). There is evidence on patient safety and good outcome in neurotrauma management by trauma surgeons. Refresher training of 1 week every 2 years has been recommended to prevent skill attrition after 2-week neurotrauma training led by a neurosurgeon. Uninterrupted run of 3-year trauma surgery residency program at JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India, incorporating in-house neurotrauma training is a testimony to need and utility of this approach. A “readily available neurosurgeon when needed” is a scarce resource in most parts of world. Therefore, trauma surgeon is best suited to deliver timely care in neurotrauma and tackle this “hidden epidemic.”

Case Series of Neurotrauma Managed by General Surgeon at Ladakh — The Highest Plateau State of India

“…However, in modern India, the author could not find any article from a rural surgeon in India on his/her experiences with neurotrauma. An article from the apex trauma centre AIIMS strongly recommended that the burden of neurotrauma should be equally shared between neurosurgeon and trauma surgeon [18]. Though a trauma surgeon after MCh trauma course is a step in the right direction, a doubt exists about the availability of such super specialist in resource sparse place.…”

Should Trauma Surgeons Perform Neurosurgery in Emergencies?

“…In that sense, the article by Rattan et al forcefully put their point regarding trauma surgeons managing neurotrauma, and operating on head injury is timely. 1 There are many papers from the West and developed countries, which have been cited in the paper, which point out the advantages of such a system even in places where the resources and facilities are much more plentiful than in our country. There are many factors that favor this practice.…”

Neurotrauma Care: Time to Think Beyond Neurosurgeons and Need for Neurosurgical Interventions

“…1 This gap between demand and supply gets further widened in a country like India, where trauma, particularly traumatic brain injury related morbidity and mortality, is on a rise. 2,3 To bridge this gap, the authors have proposed an alternative that "neurotrauma and neurocritcal care" can be provided by nonneurosurgeons (e.g., trauma surgeons). 3 To better understand how neurotrauma care is possible without a trained neurosurgeon, we need to know that out of all trauma patients, only 1% need neurosurgical intervention in the form of craniotomy for mass lesions due to head injury, and out of all head injuries, only 3.6% patients require craniotomy.…”

“…2,3 To bridge this gap, the authors have proposed an alternative that "neurotrauma and neurocritcal care" can be provided by nonneurosurgeons (e.g., trauma surgeons). 3 To better understand how neurotrauma care is possible without a trained neurosurgeon, we need to know that out of all trauma patients, only 1% need neurosurgical intervention in the form of craniotomy for mass lesions due to head injury, and out of all head injuries, only 3.6% patients require craniotomy. 4 It means that almost 99% patients with trauma and 96% patients with traumatic brain injury do not require direct operative neurosurgical intervention.…”