Practice guidelines from the Brain Trauma Foundation recommend placement of an ICP monitor in trauma patients with GCS<8 and any type of intracranial hemorrhage. Some rural trauma centers may not have immediate access to a neurosurgeon for this procedure, and geography and/or weather may preclude transferring the patient. What to do?

Well, one person is guaranteed to be available at any trauma center. The trauma surgeon. Six years of data regarding placement of bolt type ICP monitors by appropriately trained and credentialed trauma surgeons or neurosurgeons was reviewed. The study was actually carried out at a Level I center, where both specialties were available. A total of 407 cases were studied. 

Here are the interesting factoids:

• Patients tended to be young (average 41 years), and male (of course)
• About one third were falls and one third were motor vehicle crashes
• Trauma surgeons placed 71% of the ICP bolts, neurosurgeons 29%
• Complication rates were low and not significantly different (2.5% for surgeons, 0.8% for neurosurgeons)

Bottom line: This study is intriguing, and I know a few centers in the US and many abroad already allow surgeons to place ICP monitors. However, this study is too small and underpowered to reach a definitive conclusion. A much larger, multicenter trial is warranted, although it will be difficult to carry out. In the meantime, if your hospital needs this resouirce, consider training your trauma surgeons for the procedure. But be sure to monitor complications and outcomes very carefully via your trauma PI process!

Related post:

• Another small study from AAST 2011
• ICP monitoring: less is more?

Reference: Placement of intracranial bolt monitors by trauma surgeons – a 6 year review. AAST 2013 Paper 20.

The August issue of Trauma MedEd is ready to go! Subscribers will receive it tonight. This issue is devoted to trauma centers. 

Included are articles on:

• The value of trauma centers
• Benefits of transport to trauma centers
• The “wallet biopsy” and trauma care
• The shortage of on-call specialists
• And more!

As mentioned above, subscribers will get the issue delivered tonight to their preferred email address. It will be available to everybody else later this week on the blog.

Check out back issues, and subscribe now! Get it first by clicking here!

TE:TNG is next week!

We’re breaking the mold for trauma talks! No more stodgy presenters reading from bullet-heavy PowerPoint slides! Away with the sore backside from sitting through an hour-long talk where the presenter goes over their time limit another 15 minutes!

The conference is now fast paced and to the point, with topics of interest to all trauma professionals (doctors, nurses, EMS, and anyone else who loves trauma). It consists of concise, 20 minute presentations interspersed with 5 minute videos of things you need to know. There are curbside consults, where we ask specialists the things you always wanted to. We’ll be taking questions for presenters from the audience and from Twitter using #TETNG13.

Here is a sample of some of the presentations:

• Scott Weingart (EMCrit) joins us live from his studio in NYC, talking about finger thoracostomy
• Michael McGonigal discusses why so much of what we think we know is wrong!
• Felix Ankel talks about the future of trauma education
• Field amputation, dislocated hip reduction, IO lines and more!

For those of you in the upper Midwest of the US, please join us live in St. Paul for this 4 hour program. It is located at the Minnesota History Center in a beautiful 300 seat auditorium. There is a fee to attend the live program to cover CME/CEU, food and parking. 

For those who cannot attend the live event, it will be streamed live on the internet beginning at 8am CST. Obviously, this is free but no CME/CEU’s will be offered. Park in your garage and get food from your own kitchen. 

And for anyone who just can’t tear themselves away from work on the morning of September 5, all content will be available for free on YouTube shortly after the conference.

For more information, and to register for the live event, go to TETNG.org 

Please feel free to email or comment with questions and suggestions!