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