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 neurosurgeons' 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 percent of respondents practiced in an academic setting, and 51% reported that neurosurgery residents were available in their hospitals at night and on weekends. Approximately 60% reported that neurosurgeons were in charge of the care of adults with isolated head injuries (HIs) who had been operated on. A similar percentage thought that neurosurgeons should be in charge of such patients' care. Only 31.5% indicated that neurosurgeons were in charge if no operation had been performed (P < 0.001 versus patients who had been operated on), but 42.1% thought that neurosurgeons should be in charge of patients who had not been operated on (P < 0.001 versus neurosurgeons who actually were in charge of such patients). The same question was asked with regard to adults with both HIs and systemic injuries and with regard to children with HIs 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 charge than actually were in charge of patients with HIs. Reluctance to insert intracranial pressure monitors was the most commonly reported problem (44.8% of respondents) with regard to neurosurgeons' care of patients with HIs. All problems were reported to be significantly more common when in-house neurosurgery residents were not available. More than 40% of respondents indicated that non-neurosurgeons should be allowed to insert intracranial pressure 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 patients with HIs to other specialists, but more frequent leadership of neurosurgeons 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.