A prospective and comparative study of referrals to neurosurgeons in an emergency department: does use of guidelines for head trauma affect the assessment made by non-neurosurgeons?

BACKGROUND Restriction of the direct admission of all head-injured patients to the neurosurgical unit remains common practice in many parts of the world. This study was conducted to assess if the initial neurological examination of patients with a head trauma and their management are adequately performed before the referrals and also to determine whether strict use of guidelines for the management of patients with head injuries can be effective. METHODS The referrals of head-injured patients from different doctors in the emergency department to the same neurosurgeon were assessed prospectively in two separate 6-month periods: the period before training of the non-neurosurgeon physicians on the selection of cases that require a neurosurgical intervention and the period after training. RESULTS The first part of study showed that initial neurological examination of patients with a head trauma and their management were not performed correctly by the non-neurosurgeon physicians. However, the second study period showed that non-neurosurgeon physicians performed a more accurate selection of patients requiring a neurosurgical intervention after receiving systematic neurosurgical training for at least 6 months. CONCLUSION In hospitals where there are no specialist trauma surgeons, neurosurgeons should train non-neurosurgeons regarding the accurate selection of neurosurgical cases that need an emergency intervention. In this training, use of guidelines for the management of head injuries is very effective.