Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.
Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.
复制标题
移动儿科神经外科手术：为远程或紧急儿科患者提供快速反应的神经外科手术。
DOI：
10.3171/2015.2.peds14310
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
A. Berry
中科院分区：
文献类型：
--
作者：
B. Owler;K. Carmo;Wendy Bladwell;T. A. Fa'asalele;J. Roxburgh;T. Kendrick;A. Berry
对象
时间紧迫的神经外科疾病需要紧急手术治疗，以防止死亡或神经功能缺损。在新南威尔士州/澳大利亚首都直辖区，患者与神经外科护理的距离通常很远，这对急性神经外科疾病患者的及时护理提出了挑战。
方法
制定了一项方案，以促进当地的顾问神经外科手术。患有急性、时间紧迫的神经外科急症的儿童在通常不提供神经外科手术的医院接受手术。作者描述了开发的协议，其使用的结果，以及在9个最初的情况下，该协议已被使用的经验教训。三个案例进行了详细讨论。
结果
9名儿童在5家农村医院接受了神经外科医生的治疗，2名儿童在一家较小的大都市医院接受了治疗。公路救护车，固定翼飞机和医疗直升机被用来运送新生儿和儿科紧急运输服务（NETS）团队，神经外科医生和病人。在每种情况下，明确的神经外科干预的时间显着减少。从初始医院分诊到手术开始时间的中位间隔为3：55小时（四分位距[IQR] 03：29-05：20小时）。到达患者的中位距离为232 km（范围23-637 km）。从请求患者取回的初始NETS呼叫到手术开始时间的中位间隔为3：15小时（IQR 00：47-03：37小时）。估计的中位“节省时间”约为3：00小时（IQR 1：44-3：15小时），相比之下，将儿童送回三级中心的旅行时间为8：31小时（IQR 6：56-10：08小时）。
结论
远程紧急神经外科干预可以安全有效地进行。这种做法适用于距离限制患者紧急获得三级儿科护理的国家。这种做法是挽救生命的一些儿童头部受伤和其他急性神经外科条件。
OBJECT
Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions.
METHODS
A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail.
RESULTS
Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours).
CONCLUSIONS
Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.