PAJT Trends in Neurosurgical Management10.5005/jp-journals-10030-1081 of Traumatic Brain Injury in Colombia ORIGINAL RESEARCH Trends in Neurosurgical Management of Traumatic Brain Injury in Colombia 1Luis Rafael Moscote, 2Claudia Marcela Restrepo Lugo, 3Sandra Castellar, 4Gabriel Alcala 5Juan Carlos Puyana, 6Andres Mariano Rubiano ABSTRACT Keywords: Head trauma, Survey, Neurosurgery, Neurotrauma, Traumatic brain injury. Introduction: Traumatic brain injury (TBI) is a public health problem with higher impact in low and middle income countries. How to cite this article: Moscote LR, Lugo CMR, Castellar S, Surgical management of TBI in Colombia is a common interven- Alcala G, Puyana JC, Rubiano AM. Trends in Neurosurgical tion performed by neurosurgeons but there is little knowledge Management of Traumatic Brain Injury in Colombia. Panam J about their preferences and trends during the care. Trauma Crit Care Emerg Surg 2014;3(1):23-28. Materials and methods: We designed a 19 questions survey Source of support: Nil based on previous studies in high income settings. Through the Colombian Association of Neurosurgery website contact Conflict of interest: None list, we submit the survey to 324 registered neurosurgeons. Statistical analysis was performed using frequencies of nominal RESUMEN and quantitative data. Introducción: El trauma craneoencefálico es un problema de Results: The response number was 47 (14.8%). Around 97.8% salud pública que genera un mayor impacto en países de bajos were males and 66% have more than 5 years in practice. Thirty y medianos ingresos. El tratamiento quirúrgico de la lesión percent operate between 50 and 100 cases of TBI and 65.9% traumática cerebral es una intervención común realizada por work in at least two facilities. The 95.74% consider that trauma los neurocirujanos, pero existe poco conocimiento acerca de surgery is not well paid by the system. Only 12.5% of the neuro- las preferencias y las tendencias al brindar este cuidado en surgeons are more devoted to neurotrauma and 20.8% are Colombia. practicing more spine surgery. The 36.1% will choose not to do trauma neurosurgery if they have the opportunity. Resources Materiales y métodos: Se diseñó un estudio de 19 preguntas for emergency craniotomies in their facilities were considered basadas en estudios previos realizados en países de alto ing- adequate by 93.6% of the responders. reso. A través de la página web de la Asociación Colombiana de Neurocirugía, se encuestó a 324 neurocirujanos registrados Conclusion: Caring for patients with neurotrauma is not an en esta página. Se realizó un análisis estadístico utilizando attractive option for some practicing neurosurgeons in Colombia. frecuencias de datos nominales y cuantitativos. Traumatic brain injury cases are frequent in daily practice but some neurosurgeons prefer not to do trauma surgery if they Resultados: El número de respuestas fueron 47(14,8%). El have the option. Institutions have basic resources to perform 97,8% eran hombres y el 66% tenían más de 5 años en la trauma neurosurgery but the surgery is not well paid by the práctica médica. El 30% interviene entre 50 y 100 casos de health system according to the neurosurgeons perspective. trauma craneoencefálico al año y el 65,9% trabaja en por lo menos dos instituciones de salud. El 95,74% considera que la cirugía de trauma no está bien remunerada por el sistema de salud colombiano. Sólo 12,5% de los neurocirujanos están dedi- 1Neurosurgeon, 2,4Resident Physician, 3Medical Doctor 5Trauma and Critical Care Surgeon, 6Neurosurgeon and cados a neurotrauma y el 20,8% están dedicados a cirugía de Professor of Neurosciences columna. El 36,1% decidiría no hacer neurocirugía de trauma si tuvieran la oportunidad. El 93,6% de los encuestados considera 1,3,4 Department of Neurological Surgery, University of que actualmente tiene los recursos apropiados para realizar Cartagena, Colombia craneotomías de emergencia en sus instituciones. 2Department of Neurological Surgery Service, Central Military Hospital, Bogotá, Colombia Conclusión: El cuidado de los pacientes con trauma neuro- lógico no es una opción atractiva para algunos neurocirujanos 5 Department of Trauma and Critical Care, University of en Colombia. Los casos de lesión traumática cerebral son Pittsburgh Medical Center, Pittsburgh, USA frecuentes en la práctica diaria, pero algunos neurocirujanos 6Department of Neurosurgery and Critical Care, South preferirían no hacer cirugía de trauma si tuvieran la opción. Las Colombian University, Neiva University Hospital, Huila instituciones de salud tienen actualmente los recursos básicos Colombia para llevar a cabo el manejo neuroquirúrgico del trauma, pero la cirugía no está bien remunerada por el sistema salud Colom- Corresponding Author: Andres Mariano Rubiano Neurosurgeon, Professor of Neurosciences, Department of biano de acuerdo a las expectativas de los neurocirujanos Neurosurgery and Critical Care, Neiva University Hospital encuestados. Huila, Colombia, Phone: 573132514132, e-mail: rubianoam@ Palabras claves: Trauma de cráneo, Encuesta, Neurocirugía, gmail.com Neurotrauma, Trauma craneoencefálico. Panamerican Journal of Trauma, Critical Care & Emergency Surgery, January-April 2014;3(1):23-28 23 Luis Rafael Moscote et al INTRODUCTION Colombia; a country where TBI is a public health problem, availability of neurosurgeons is limited, especially in rural The World Health Organization (WHO) has been evaluating areas and the healthcare system is in crisis. We hypothesized epidemiological data with the objective of identifying critical that lack of organized regional trauma systems and inap- factors related to trauma morbidity and mortality worldwide. propriate reimbursement of medical care to physicians and Trauma has increased significantly in the last several decades hospitals may play a major role in the motivation for care and approximately 16,000 people die every day all around from neurosurgeons and the quality of care for neurotrauma the globe as a result of some traumatic injury, and for each patients in Colombia. one of these deaths many others are severely disabled.1 Motor vehicle-related collisions (MVCs) are the second most common cause of death worldwide in the age range of 15 to MATERIALS AND METHODS 30 years and interpersonal violence is the sixth most common A 19-question survey was designed in a web platform. All cause of death for 15 to 30-year-old. Ninety percent of the 324 members registered in the web site of the Colombian mortality and morbidity caused by trauma is concentrated Association of Neurosurgery. in low- and middle-income countries, especially in Latin Association of neurosurgery was contacted. The survey 1 America, Africa and Asia. Colombia is one of the Latin asked for administrative and technical aspects of the neuro- American countries with highest rates of violence due to trauma surgery including: affiliation, demographic and the war on drugs and the internal social conflict. training characteristics, facilities, administrative issues of According to the National Legal Medicine Institute from the health system and resources and technical preferences in Colombia, in 2011, 25,709 people died due to violence, the practice of neurotrauma surgery. These questions were motor vehicle accidents and nonintentional accidents. In formulated for adult and pediatric population. Answers were the same year 294,267 people were injured due to the same analyzed using SPSS 17.0 software (SPSS, Inc. Chicago, IL). causes plus home/domestic related violence. This means that Analysis of frequency and nominal or quantitative data was 2 in 2011, near 70 people die and 800 were injured every day. performed. Close to 70% of the people who dies and 40% of the injured 1 had an associated head injury. In a survey (2007) of the RESULTS American Association of Neurological Surgeons, evaluating the allocation and availability of neurosurgeons worldwide, The survey was available on line for a 2 months period, it was identified that neurosurgeons were concentrated in from January to March of 2012. The available population main cities, without appropriate coverage in rural zones and included 324 registered neurosurgeons from the Colombian intermediate suburban cities. This phenomenon was more Association of Neurosurgery. This association is the only pronounced in low and middle-income countries.3 This local association for specialists graduated from neurological document shows that around 23,940 neurosurgeons were surgery training programs that practice in Colombia. Forty- available for the entire world population, approximately seven responses were received from 324 e-mails (14.8% res- one for each 230,000 inhabitants. Fifty percent of these ponse rate). Forty-six (97.8%) of the respondents were men neurosurgeons are concentrated in countries of high and compared to only one email received from a woman (2.2%). high medium income, and they cover only 30 to 40% of the Answers regarding neurosurgical practice are shown in world’s population, whereas in low and low-middle income Table 1. countries neurosurgeons cover approximately 60 to 70% of There were 72.3% of the respondents who practiced the actual trauma population.3 general neurosurgery without subspecialty training; 20.8% Just in the United States, nearly 20% of neurosurgeons were spine neurosurgeons. Only 12.5% consider their selves who are in charge of neurotrauma cases would prefer not more devoted to trauma neurosurgery. Sixty-six percent to do it, due to issues of financial reimbursement,