How well do neurosurgeons care for trauma patients? A survey of the membership of the American Association for the Surgery of Trauma

OBJECTIVE: To quantify the trauma community's perceptions about neurosurgeo ns' involvement in trauma. METHODS: Mail survey of the membership of the American Association for the Surgery of Trauma. RESULTS: The response rate was 33.6% (280 of 833 mailings). Eighty-four per cent of respondents practiced in an academic setting, and 51% reported that neurosurgery residents were available in their hospitals at night and on w eekends. Approximately 60% reported that neurosurgeons were in charge of th e care of adults with isolated head injuries (Hls) who had been operated on . A similar percentage thought that neurosurgeons should be in charge of su ch patients' care. Only 31.5% indicated that neurosurgeons were in charge i f no operation had been performed (P < 0.001 versus patients who had been o perated on), but 42.1% thought that neurosurgeons should be in charge of pa tients who had not been operated on (P < 0.001 versus neurosurgeons who act ually were in charge of such patients). The same question was asked with re gard to adults with both His and systemic injuries and with regard to child ren with Mis with and without systemic injuries. In general, the actuality of a leadership role for neurosurgeons depended on whether a craniotomy had been performed, and it was believed that more neurosurgeons should be in c harge than actually were in charge of patients with His. Reluctance to inse rt intracranial pressure monitors was the most commonly reported problem (4 4.8% of respondents) with regard to neurosurgeons' care of patients with Hi s. All problems were reported to be significantly more common when in-house neurosurgery residents were not available. More than 40% of respondents in dicated that non-neurosurgeons should be allowed to insert intracranial pre ssure monitors, and 14% thought that non-neurosurgeons should be allowed to perform trauma craniotomies. These opinions were strongly associated with the reporting of problems in neurosurgeons' performance in these areas (P < 0.001 and P = 0.001, respectively). CONCLUSION: Neurosurgeons frequently yield responsibility for managing pati ents with His to other specialists, but more frequent leadership of neurosu rgeons in this area would be welcome. Reported problems with neurosurgical care of trauma patients may be related to a lack of immediate availability of neurosurgeons, such as the absence of in-house neurosurgery residents at night. Failure of neurosurgeons to address perceived deficiencies in their care of trauma patients may lead to serious erosion of the central role of neurosurgeons in managing patients with His.