Referral Pattern to Neurosurgeons in a tertiary care teaching Hospital

Abstract

Background: Due to lack of pre-hospital care, direct admission of traumatic brain injury (TBI) patients to dedicated neurosurgical department remains difficult in many parts of world. Objective: The present pilot study was conducted to understand the referral pattern of patients to the neurosurgery department and to develop an algorithm to stratify the spectrum of cases as per the severity of condition and possibility of direct neurosurgical care. Materials and Methods: Details of referral patterns, demographic and clinical profile, management and outcome of consecutive TBI cases admitted in the Department of Neurosurgery were collected with pre-designed proforma. Results: Of total 55 cases, 40 (73%) were males; 26 (47%) between 36-55 years age; 26 (47%) referred directly to the center; 24 (44%) self-referred; 34 (62%) referred from Emergency department; mostly (32, 58%) admitted after 12PM; 22 (40%) admitted for 16-30 days. In the analysis of investigations, 37(67%) cases had CT, 15 (27%) had MRI, 4 (7%) had X-ray, 1 (2%) undergone all three investigations, while 8 (15%) didn’t have any; mostly (42, 76%) cases were referred for the management of TBI and 38 (69%) required operative interventions. Conclusion: Our findings strongly suggest that referral of TBI cases need improvement in this part of country where hindrances delay TBI cases to reach dedicated neurological intensive care leading to delay of committed care and optimization of strategy for reduction of case fatality.

Keywords

• Head Injury
• referrals
• neurosurgical management
• tertiary care hospital