Neurosurgical Emergency Transfers to Academic Centers in Cook County

Byrne, Richard W.; Bagan, Bradley; Slavin, Konstantin V.; Curry, Daniel J.; Koski, Tyler R.; Origitano, Thomas C.

doi:10.1227/01.neu.0000317320.79106.7e

Cited by 51 publications

(40 citation statements)

References 16 publications

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“…It has been estimated that approximately 80% of these emergency transfers would be unrelated to cranial trauma. 3,4 This explains the elevated vascular/ trauma ratio of emergency and urgent cases in our series and also the number of CSF diversion procedures. A significant number of Type III CT changes in our series consisted of improperly placed ventricular catheters (20 of 51 [39.2%]).…”

mentioning

confidence: 72%

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Fontes

Smith²,

Munoz³

et al. 2014

JNS

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Object. Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence.Methods. The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test.Results. Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%-2.4% range; however, no patient required an immediate return to the operating room.Conclusions. Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination. (http://thejns.org/doi/abs/10.3171/2014.4.JNS132429) Key WoRds • computed tomography • radiography • craniotomy • reoperation • traumatic brain injuryAbbreviations used in this paper: ICU = intensive care unit; RUMC = Rush University Medical Center; TBI = traumatic brain injury.

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mentioning

confidence: 72%

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Fontes

Smith²,

Munoz³

et al. 2014

JNS

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“…The availability of neurosurgeons across the United States has dwindled as the rates of graduating neurosurgical residents has failed to catch up with the growth of the US population, with demand currently skyrocketing (55). For example, Bryne et al reports that with fewer trauma neurosurgeons available in Cook County, time to treatment for patients with emergent neurosurgical issues has increased (56). It may be possible that patients from counties with fewer neurosurgeons have limited interactions with these sub-specialized surgeons, and are therefore less likely to be referred to quality medical centers with surgeons performing a large number of these sub-specialized surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Predictors of access to pituitary tumor resection in the United States, 1988–2005

Mukherjee¹,

Zaidi²,

Kosztowski³

et al. 2009

European Journal of Endocrinology

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Objective: Surgery remains a common form of treatment for sellar and parasellar tumors involving the pituitary gland and adjacent structures. Studies have suggested that pituitary surgery procedures performed at high-volume centers are associated with less adverse outcomes, yet it remains unclear which types of patients are more likely to be admitted to such centers. We set out to determine which factors most influenced admission to these high-volume centers. Methods: A retrospective analysis of the National Inpatient Sample over an 18-year period was linked to socioeconomic and environmental data contained within the Area Resource File. Only patients undergoing transsphenoidal surgery in the United States, O18-years-old were included. The primary outcome was admission to a high-volume (O25 pituitary surgeries/year) hospital. Results: Overall, patients' odds of admission to a high-volume center increased over an 18-year time period. However, African-Americans (odds ratio, ORZ0.46), Hispanics (ORZ0.28), and Asians (ORZ0.49) experienced declining odds of admission over time. Patients from high-income brackets (ORZ1.53) and from areas with higher neurosurgeon density (ORZ1.61) were more likely to be admitted to high-volume centers. Conversely, patients coming from counties with higher poverty (ORZ0.92) were less likely to be admitted to high-volume centers. Conclusion: Racial and socioeconomic factors play a significant role in the admission of patients to highvolume pituitary surgery centers. This study demonstrates potential key policy areas for meaningful intervention to help ease disparities in access to quality care for surgical pituitary disease.

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“…The ready availability of a neurosurgeon is key in case neurosurgical intervention is required either for placement of an intraventricular catheter for emergent CSF drainage in case of obstructive hydrocephalus [10] associated with intracranial hypertension and ICP monitoring or if urgent hemicraniectomy or clot evacuation is indicated [11]. These may be potentially lifesaving or outcome modifying interventions and yet the absence of a qualified neurosurgeon at the transferring institution delays what is often an emergent procedure [12].…”

Section: Introductionmentioning

confidence: 99%