Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;7(3):100-104.
doi: 10.1016/j.afjem.2017.04.012. Epub 2017 May 6.

What intracranial pathologies are most likely to receive intervention? A preliminary study on referrals from an emergency centre with no on-site neurosurgical capabilities

Lara Nicole Goldstein  1 , Craig Beringer  1   2 , Lumé Morrow  2
Affiliations

What intracranial pathologies are most likely to receive intervention? A preliminary study on referrals from an emergency centre with no on-site neurosurgical capabilities

Lara Nicole Goldstein et al. Afr J Emerg Med. 2017 Sep.

Abstract

Introduction: Access to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities.

Methods: A one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted.

Results: A total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention.

Discussion: Based on this study's findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.

Keywords: Developing countries; Intracranial haemorrhages; Neurosurgery; Traumatic brain injuries.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Types of neurosurgical interventions (TBI, traumatic brain injury).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Rubiano A.M., Carney N., Chestnut R. Global neurotrauma research challenges and opportunities. Nature. 2015;527:S193–S197. - PubMed
    1. Norton R., Kobusingye O. Injuries. N Engl J Med. 2013;368:1723–1730. [PMID: 23635052] - PubMed
    1. Maas A.I.R., Menon D.K., Lingsma H.F. Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research. J Neurotrauma. 2012;29:32–46. [PMID: 21545277] - PMC - PubMed
    1. Caceres J.F., Goldstein J.N. Intra-cranial hemorrhage. Emerg Med Clin North Am. 2012;30:771–794. [PMID: 22974648] - PMC - PubMed
    1. Goldstein J., Gilson A. Critical care management of acute intracerebral hemorrhage. Curr Treat Options Neurol. 2011;13:204–216. [PMID: 21222062] - PMC - PubMed

LinkOut - more resources