救急医，外傷外科医，脳神経外科医による頭部外傷に対するチーム医療

抄録

Medical services for trauma patients have been recently promoted to management in emergency medical centers from individual consultation with a doctor on call. In general, in emergency medical centers, emergency doctors and/or trauma surgeons initially treat trauma patients, and then doctors from specialized departments are involved as needed. Here, we address some issues related to the management of trauma patients at emergency medical centers and report the current status of our system.

To manage trauma patients, especially multiple traumas characterized by pathophysiological diversity, we have established the trauma team, to provide comprehensive acute care to trauma patients suffering vital or potentially vital injuries, i.e., head and/or trunk injury. The initiative to establish the trauma team was taken by a trauma surgeon. From the point of view of organ-specific expertise for the surgical treatment, the team includes a trauma surgeon for the surgical management of trunk injuries and a neurosurgeon for the management of brain injuries. Firstly, doctors must be on standby in the Emergency Department at all times to attend to trauma patients. The ER physicians also participate in the initial stabilization and evaluation of trauma patients. At our Emergency Department in 2004, 40% of 3212 outpatients and 45% of 240 inpatients were categorized as trauma patients. Over half (56%) of these trauma inpatients suffered from head injuries. Acute care for the head injury patients with CT abnormalities (34% of the trauma inpatients) was provided by the trauma team which includes neurosurgeons. Neurosurgery for intracranial hematomas was performed in 8% of the trauma inpatients.

Definition of therapeutic plans for patients with multiple traumas is an important issue. To review the acute management in trauma patients with head injury, we applied TRISS as a clinical indicator of the prognosis and the indications for surgery in 30 consecutive cases with severe acute subdural hematoma (ASDH). We evaluated the physiological status of the patients, which was expressed as the Revised Trauma Score, at the time of the neurosurgical consultation. The overall mortality of the cases was 73%, while in the patients with the probability of survival (Ps) score of over 0.5 as calculated by TRISS, it was 50%. Furthermore, there was significant difference in the Ps score between cases who underwent surgical treatment and those who did not, with average Ps scores of 0.56 and 0.39, respectively. Therefore, a cutoff Ps score of 0.5 may be useful for objectively reviewing the indications for neurosurgery in patients with ASDH.