In the U.S. each year more than a million patients are seen in emergency rooms for traumatic brain injury alone, representing only a portion of the neurotrauma cases that neurosurgeons are asked to see on a daily basis. The high volume of neurotrauma cases tests the available neurosurgical resources to meet this demand and varies from region to region throughout the country.
Neurotrauma issues affecting neurosurgeons today are addressed in the following questions. These are just a few of the many questions discussed by the Neurotrauma Committee that remain on the agenda for further debate.
1. Are we adequately preparing residents for the rigors of a typical neurosurgical practice, especially in light of recent suggestions that work hours should be further restricted from 80 to 56 hours?
2. Should daily neurotrauma coverage be performed on a volunteer basis or contracted with hospitals? Certainly, the increased risk of medical liability has swayed the vast majority of neurosurgeons to consider negotiating contracts for this service as opposed to their predecessors who did it voluntarily.
3. Do we provide all neurosurgery residents with sufficient training to offer full-scale neurotrauma services and adequate coverage? At the same time, how do we justify general surgeons performing neurosurgical procedures and argue it is in the best interest of patient care?
4. In response to an increased need for neurosurgeons to be available for neurotrauma management, should we consider the concept of modifying the training of neurosurgeons to a fast track, establishing basic skills for neurotrauma along with basic cranial and spine skills? How do we ensure our role as architects in the regionalization of neurotrauma care?
5. Lastly, how are we going to respond to the expected exodus of veteran neurosurgeons from neurotrauma coverage rosters due to increasing concerns about malpractice and liability and work hours?
In 2007, Shelly Timmons, MD, became chair of the committee, following the fine work in that capacity of Dominic Esposito, MD. The committee takes an active role in formulating responses to resolutions brought forth by members of the CSNS in addition to tackling some of the more volatile issues of neurotrauma care affecting not only neurosurgeons, but society as a whole.
Additional information on how the Neurotrauma Committee functions and how to join this committee is available on the CSNS Web site. In an interview posted on the site, Dr. Timmons answers a number of questions about the workings of this committee and raises issues to which neurosurgeons should feel compelled to respond.
Ann R. Stroink, MD, is member of the Editorial/Publication Committee of the Council of State Neurosurgical Societies, www.csnsonline.org. The author reported no conflicts for disclosure.