Placement of Intracranial Pressure Monitors by Nonneurosurgeons: Good Outcomes are Achieved

Authors: Marcus A Barber, MD, Stephen D Helmer, PhD, Jonathan TMorgan, DO, James M Haan, MD.

Invited Discussant: J. Wayne Meredith

Introduction: Traumatic Brain Injury remains one of the most prevalent and costly injuries encountered. Traditionally, neurosurgeons have placed intracranial pressure (ICP) monitors. However, neurosurgery coverage problems may result in delayed placement. This study sought to confirm ICP monitors may be safely inserted by non-neurosurgeons. Methods: A 10-year retrospective review of ICP placements at a Level 1 Trauma Center. Results represent demographic variables, the incidence of complications between monitors placed by general surgical residents, trauma surgeons and neurosurgeons, and mortality. Results: Patients in this study totaled 557. Average age, hospital length of stay and injury severity score were 38.2 + -  22.3 yrs., 15.9 + - 19.1 days and 27.6 + - 11.6, respectively. The majority of patients were male (71.6%), and injured in motor vehicle crashes (51.5%), or falls (20.1%). The majority of ICP monitors were placed by residents under trauma attending supervision (83.3%), neurosurgeons (11.3%), and trauma surgeons (5.4%). One CNS infection occurred in a patient treated by a resident. Type of physician placing the monitor had no effect on complications. Of the three patients with iatrogenic bleed, no morbidity or mortality was attributed to monitor placement.

 

Parameter Resident Neurosurgeon Trauma Surgeon P-Value
Number  464 63 30  
Injury Severity Score 28.0 + - 12.0 23.0 + -  9.0 24.0 + -  8.0 <0.001
Intracranial Bleed due
to Monitor
0.7% (3) 0.0% (0) 0.0% (0) 0.738
Monitor Malfunction 5.8% (27) 4.8% (3) 3.4% (1) 0.811
Monitor Dislodgement 4.3% (20) 0.0% (0) 3.3% (1) 0.261
Monitor Replaced 13.1% (61) 11.1% (7) 10.0% (3) 0.899
Death 28.0% (130) 23.8% (15) 13.3% (4) 0.187

Conclusions: Our results demonstrate that the placement of ICP monitors may be performed safely by neurosurgeons and appropriately trained non-neurosurgeons alike with low rates of complication. This procedure should be considered a core skill for trauma surgeons and surgical residents alike.

 

Reference: Placement of intracranial pressure monitors by non-neurosurgeons: good outcomes are achieved. AAST (American Asociation for the Surgery of Trauma) 2011 Annual Meeting, Paper 72. 

Source: AAST