Document Detail


Emergency craniotomy in a rural Level III trauma center.
MedLine Citation:
PMID:  9637153     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with closed head injury and expanding epidural (EDH) or subdural (SDH) hematoma require urgent craniotomy for decompression and control of hemorrhage. In remote areas where neurosurgeons are not available, trauma surgeons may occasionally need to intervene to avert progressive neurologic injury and death. In 1990, a young man with rapidly deteriorating neurologic signs underwent emergency burr hole decompression of a combined EDH/SDH at our hospital, with complete recovery. In anticipation of future need, five surgeons at our rural, American College of Surgeons-verified Level III trauma center participated in a neurosurgeon-directed course in emergency craniotomy. Since January 1, 1991, 792 patients have been entered into the trauma registry, including 60 with closed head injury and Glasgow Coma Scale (GCS) score of 13 or less. All but seven were transferred to a regional Level II trauma center, which is a minimum flight time of 1 hour each way. All patients with EDH (5) and 2 of 14 with SDH were deemed too unstable for transport and underwent burr hole decompression followed by immediate transfer. All craniotomies were approved by the consulting neurosurgeon and were done for computed tomography-confirmed lesions combined with neurologic deterioration as demonstrated by (1) GCS score of 8 or less, (2) lateralizing signs (dilated pupil, hemiparesis), or (3) development of combined bradycardia and hypertension. One patient with a GCS score of 3 on arrival died. Seven survivors (mean follow-up, 3.9 years; range, 1-6.5 years), including the index case, function independently, although one survivor has moderate cognitive and motor impairment. We conclude that early craniotomy for expanding epidural and subdural hematomas by properly trained surgeons may save lives and reduce morbidity in properly selected cases when timely access to a neurosurgeon is not possible.
Authors:
C F Rinker; F G McMurry; V R Groeneweg; F F Bahnson; K L Banks; D M Gannon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  44     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-07-02     Completed Date:  1998-07-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  984-9; discussion 989-90     Citation Subset:  AIM; IM    
Affiliation:
Montana State University and Bozeman Deaconess Hospital, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Child, Preschool
Craniotomy*
Diagnosis, Differential
Emergencies
Female
Glasgow Coma Scale
Head Injuries, Closed / diagnosis*,  surgery*
Hospital Bed Capacity, under 100
Humans
Infant
Male
Middle Aged
Montana
Rural Health
Trauma Centers
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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