Assessment of a triage protocol for emergent neurosurgical cases at a single institution. World neurosurgery Ehresman, J., Ahmed, A. K., Lubelski, D., Pennington, Z., Jiang, B., Zygourakis, C., Cottrill, E., Theodore, N. 2019


OBJECTIVE: Level I trauma centers use patient triaging systems to deploy neurosurgical resources and pursue good outcomes; however, data describing the effectiveness these triage systems are lacking. We reviewed the leveling protocol (cases designated urgent/emergent) of a regional Level I trauma center to obtain epidemiological data about the efficiency of that system and identify areas for improvement.METHODS: We retrospectively reviewed leveled neurosurgical cases from January 2015-October 2017, assessing surgery date, neurosurgical procedure, posted surgical urgency level (Levels 1-3, with 1 being most urgent), and "post-to-room time" (ie, the time between initial leveling and admission of the patient to the operating room). Mean post-to-room times were compared between case types using one-way ANOVA with post-hoc Tukey's HSD analysis.RESULTS: Of 1,469 cases, 577 (39.3%) were shunt placement/revision, 231 (15.7%) were craniectomy or craniotomy for hematoma, 147 (10.0%) were craniectomy or craniotomy for tumor, and 514 (35.0%) were for other indications. Among Level 1 cases, post-to-room time was lowest for craniotomies to evacuate intracranial hematoma (mean:16.2 minutes) and highest for spinal decompression procedures and wound washouts (mean: 36.2 and 42.4 minutes).CONCLUSION: This is the first study of variability in post-to-room timing as a function of surgical urgency/indication. The most common leveled cases were craniectomies or craniotomies to relieve increased intracranial pressure, which were also the most common Level 1 cases. Significant variability occurred within each leveling category; thus, further investigation is required.

View details for DOI 10.1016/j.wneu.2019.12.005

View details for PubMedID 31821911