Temporal course of secondary transfer of neurosurgical intensive care patients

Abstract-Text (inkl. Referenzen und Bildunterschriften)

Objective: Patients with acute cerebral or spinal pathologies require treatment in a specialized neurocenter. These life-threatening conditions are often diagnosed in tertiary-care hospitals without an appropriate neurosurgical and neurointensive care. Therefore an urgent transfer to a neurocenter is mandatory to ensure the timely begin of necessary surgical and/or neurointensive interventions. The organization and execution of secondary transfers require interdisciplinary cooperation and are influenced by many external factors, which may lead to disastrous delays in patient transfer. In this study, we examine this process for possible influencing factors. Methods: This is an ongoing prospective observational study including all patient with life-threatening cerebral or spinal conditions presented to our department from tertiary-care hospitals. We recorded the time point of peripheral patient admittance and the periods until diagnosis was established, the patient was presented to our department, transfer was organized and conducted and the patient finally arrived in our department. Epidemiological patient data in addition to data provided by the emergency medical services (EMS) and the tertiary-care hospitals were collected in a standardized questionnaire. Results: So far, 34 patients (mean age 62.6±13.1 years, 56% female) have been included with complete data sets. Most tertiary hospitals were within 30 km distance (52%). Time between confirmed neurological emergency and contact with our department was 41±42 minutes and time until arrival of EMS to pick up the patient in the tertiary hospital was 28±30 minutes. The actual transfer took 23±9 minutes and positively correlated with the distance (p<0.001). Overall time between CT and arrival in our department was 104±38 minutes and did not correlate with diagnosis (p=0.449), initial Glasgow coma scale (p=0.957) or patient age (p=0.059) but correlated significantly with time of day (p<0.001) with longer intervals during working hours as compared to nights (114 vs 92 minutes). Conclusion: Our preliminary analysis shows that relevant time passes before diagnostic measures are performed and the transfer is organized. During working hours a significant delay occurs potentially due to the work load in tertiary hospitals. Our analysis underlines the necessity of establishing a network and training non-neurosurgical personnel in tertiary hospitals to improve awareness and shorten transfer times.