PMID- 26090548
OWN - NLM
STAT- MEDLINE
DCOM- 20151228
LR  - 20220316
IS  - 1933-0715 (Electronic)
IS  - 1933-0707 (Linking)
VI  - 16
IP  - 3
DP  - 2015 Sep
TI  - Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent 
      pediatric patients.
PG  - 340-5
LID - 10.3171/2015.2.PEDS14310 [doi]
AB  - 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.
FAU - Owler, Brian K
AU  - Owler BK
AD  - Discipline of Child Health and Paediatrics, Children's Hospital at Westmead 
      Clinical School, University of Sydney;
AD  - Department of Neurosurgery.
FAU - Carmo, Kathryn A Browning
AU  - Carmo KA
AD  - Discipline of Child Health and Paediatrics, Children's Hospital at Westmead 
      Clinical School, University of Sydney;
AD  - Grace Centre for Newborn Intensive Care, Children's Hospital at Westmead, Sydney 
      Children's Hospital Network, Sydney, Australia;
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
FAU - Bladwell, Wendy
AU  - Bladwell W
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
FAU - Fa'asalele, T Arieta
AU  - Fa'asalele TA
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
FAU - Roxburgh, Jane
AU  - Roxburgh J
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
FAU - Kendrick, Tina
AU  - Kendrick T
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
FAU - Berry, Andrew
AU  - Berry A
AD  - Newborn and Paediatric Emergency Transport Service (NETS), New South Wales, 
      Australia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20150619
PL  - United States
TA  - J Neurosurg Pediatr
JT  - Journal of neurosurgery. Pediatrics
JID - 101463759
SB  - IM
MH  - Accidents, Home
MH  - Adolescent
MH  - Cerebral Hemorrhage/complications/*surgery
MH  - Child
MH  - Child, Preschool
MH  - Clinical Protocols
MH  - Craniocerebral Trauma/complications
MH  - *Emergencies
MH  - Female
MH  - Glasgow Coma Scale
MH  - Headache/etiology
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - *Neurosurgery/methods/standards/trends
MH  - *Neurosurgical Procedures/methods/standards
MH  - New South Wales
MH  - *Patient Transfer
MH  - Seizures/etiology
OTO - NOTNLM
OT  - ACT = Australian Capital Territory
OT  - AVM = arteriovenous malformation
OT  - EDH = extradural hematoma
OT  - EVD = external ventricular drain
OT  - GCS = Glasgow Coma Scale
OT  - ICH = intracranial hematoma
OT  - ICP = intracranial pressure
OT  - IQR = interquartile range
OT  - NETS = Newborn and Paediatric Emergency Transport Service
OT  - NSW = New South Wales
OT  - PICU = pediatric intensive care unit
OT  - neurosurgery
OT  - outcome
OT  - pediatric
OT  - transfer
EDAT- 2015/06/20 06:00
MHDA- 2015/12/29 06:00
CRDT- 2015/06/20 06:00
PHST- 2015/06/20 06:00 [entrez]
PHST- 2015/06/20 06:00 [pubmed]
PHST- 2015/12/29 06:00 [medline]
AID - 10.3171/2015.2.PEDS14310 [doi]
PST - ppublish
SO  - J Neurosurg Pediatr. 2015 Sep;16(3):340-5. doi: 10.3171/2015.2.PEDS14310. Epub 
      2015 Jun 19.