INTENT (EXPECTED OUTCOMES)

  • Emergency life-saving cranial procedures will be performed by non-neurosurgeons only when transfer to a neurosurgeon is not possible within a clinically acceptable timeframe.
  • Emergency life-saving cranial procedures will be performed by non-neurosurgeons for patients meeting the recommended clinical indications.
  • Only patients with post-resuscitation GCS ≥ 4 undergo emergency life-saving cranial procedures.
  • Non-neurosurgeons will perform emergency life-saving cranial procedures after teleconsultation with a neurosurgeon.

 

PERFORMANCE / ADHERENCE MEASURES

1. Non-availability of a neurosurgeon or anticipated length of time > 4 hours to arrive at a facility with a neurosurgeon was documented.

2. Teleconsultation with a neurosurgeon prior to craniectomy is documented.

3. The following indications for craniectomy by a non-neurosurgeon were documented:

  • Brain injury with a presenting GCS ≤ 8 AND lateralizing cortical dysfunction (unilateral dilated pupil or hemiparesis) with either
  • Hemodynamic dysfunction: hypertension, bradycardia, and respiratory variation (Cushing’s reflex), OR
  • Failure of maximal critical care management manifested by the occurrence of a new lateralizing cortical finding (hemiparesis, rapidly expanding pupil) and/or further decline in GCS off of sedation.

4. Use of an electric drill for craniectomy procedure was documented.

5. Documented GCS prior to craniectomy at Role 2 was ≥ 4 and ≤ 8.

 

DATA SOURCE

  • Patient Record
  • Department of Defense Trauma Registry (DoDTR)
  • ICU flow sheet

 

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the Joint Trauma System (JTS) Director and the JTS Performance Improvement Branch.

 

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance and PI monitoring at the local level with this CPG.