Rural neurotrauma in Australia: implications for surgical training.

BACKGROUND Australia's vast size and small population preclude a neurosurgical service in most rural areas. Thus, general surgeons often initially manage rural neurotrauma. This study aimed to define the neurotrauma surgical caseload in rural Australia and to examine the level of training and confidence of rural surgeons for neurotrauma management. METHODS A questionnaire was sent to all Australian members of the Division of Rural Surgery of the Royal Australasian College of Surgeons. Responses were grouped by distance from a neurosurgical centre and analysed using one-way anova. RESULTS The response rate was 91%, and 161 rural surgeons were included. In total, 90 surgeons carried out approximately 600 procedures for neurotrauma in 5 years. The number of procedures per surgeon increased with distance from a neurosurgical centre (P < 0.0001), as did pre-transport delays (P < 0.001). Combined pre-transport and transport time was at least 2 h for 84% of surgeons. The majority (75% or more) of rural surgeons accessed hospitals with necessary basic infrastructure, including 24-h computed tomography scan, emergency department, and intensive care unit. There was no association between distance from a neurosurgical centre and level of neurosurgical training. Only 28% of rural surgeons had neurosurgery training more advanced than resident level. However, confidence with management of cranial trauma increased significantly with distance. More distant surgeons felt more confident with computed tomography reading (P = 0.02); burr hole (P = 0.02); craniotomy (P = 0.03) and intracranial pressure monitor insertion (P < 0.0001). CONCLUSIONS A significant volume of neurotrauma is managed surgically in rural Australia as dictated by distance. However, neurotrauma training of rural surgeons has occurred on an ad hoc basis, with those most exposed and most distant developing some confidence. Evidence for specific adequate training is lacking, but this study suggests that it is necessary.